Patients want care through the end of life that aligns with their personal values and preferences. This is especially important when patients cannot communicate wishes for themselves, making an advance directive a crucial element of care. Through its Institute for Human Caring, Providence St. Joseph Health, the nation’s fourth-largest health system, has spearheaded an initiative to foster care through end of life discussions and increasing the number of patients with advance directives on file. This is being accomplished through patient education, automation, workflow considerations, and analytics showing positive engagement with the materials (65% of patients open the email and 35% download the advance directive). Also, since about a quarter of Medicare spending is going to care during the last year of life, and Medicare’s enrollment is predicted to rise to more than 90 million people by 2050, there is an opportunity to make a meaningful impact by addressing care through the end of life in a compassionate and practical manner.