Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilization

Abstract

Background: New population health community-based models of palliative care can result in more compassionate, affordable, and sustainable high-quality care.Objectives: We evaluated utilization and cost outcomes of a standardized, population health community-based palliative care program provided by nurses and social workers.Design: We conducted a retrospective propensity-adjusted study to quantify cost savings and resource utilization associated with a community-based palliative care program. We analyzed claims data from a Medicare Advantage (MA) plan and used a proprietary predictive model to identify 804 members at high risk for overmedicalized end-of-life care. We enrolled 204 members in the palliative care program and compared them with 600 who received standard, telephonic, health plan case management. We excluded members with fewer than two months of enrolled experience or those with insufficient data for analysis, leaving 176 members in the study group and 570 in the control group for evaluation. We compared differences in utilization and costs (medical and pharmacy), hospital admissions, bed days (acute and intensive care unit [ICU]), and emergency department visits.Setting/Subjects: A 30,000-member MA plan and a health system in Central Ohio between October 2015 and June 2016.Results: Members who received community-based palliative care showed a statistically significant 20% reduction in total medical costs ($619 per enrolled member per month), 38% reduction in ICU admissions, 33% reduction in hospital admissions, and 12% reduction in hospital days.Conclusion: A structured nurse and social work model of community-based palliative care using a predictive model to identify MA candidates for intervention can reduce utilization and medical costs.

Association between palliative care and healthcare outcomes among adults with terminal non-cancer illness: population based matched cohort study

“…Patients, caregivers, and healthcare systems struggle with the growing burden of medical complexity that is also associated with poor quality of life and high healthcare expenditure. 1 2 3 4 5 6 7 8 49 End-of-life care that involves hospital admission and intensive care unit admission is costly and potentially burdensome. Our study supports the role palliative care has in providing high value end-of-life care to people dying from cancer and most non-cancer illness.…”

“…Patients nearing the end of life often have high rates of costly healthcare, including emergency department visits and admissions to hospital, which could be avoidable 1. These potentially burdensome interventions are associated with poor quality of life 12345678. Consequently, the demand for palliative care is rapidly growing.…”

“… 1 These potentially burdensome interventions are associated with poor quality of life. 1 2 3 4 5 6 7 8 Consequently, the demand for palliative care is rapidly growing. The primary goal of palliative care is to improve quality of life and reduce symptom burden.…”

Palliative care and infection management at end of life in nursing homes: A descriptive survey

“…• • In suspected urinary tract infection at the end of life, about two-third of nursing homes would catheterize the resident to obtain a urine specimen and begin treating with antibiotics. transfers, 52,53 enhanced symptom management, [54][55][56] higher care satisfaction, 54,57 and lower use of aggressive medical treatments (e.g. intravenous antibiotics).…”

“…intravenous antibiotics). 55,57,58 Compared to hospice care, which requires care recipients to have a life expectancy of 6 months or less, 49,59 palliative care should occur earlier along the continuum of care and may be more appropriate for long-term nursing home residents who have less predictable illness trajectories. 60,61 Improving palliative care in nursing homes has been proposed as one key strategy to improve infection management and reduce the use of antibiotics at the end of life.…”