Improving Value of Care for Older Adults With Advanced Medical Illness and Functional Decline: Cost Analyses of a Home-Based Palliative Care Program

Chen, Christina Y.; Naessens, James M.; Takahashi, Paul Y.; McCoy, Rozalina G.; Borah, Bijan J.; Borkenhagen, Lynn S.; Kimeu, Ashley K.; Rojas, Ricardo L.; Johnson, Matt; Visscher, Sue L.; Stephen, S.; Thorsteinsdottir, Björg; Hanson, Gregory J.

doi:10.1016/j.jpainsymman.2018.08.015

Cited by 12 publications

(15 citation statements)

References 21 publications

(23 reference statements)

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“…20 At Mayo Clinic, Chen et al combined the Mayo Elder Risk Assessment index 21 with the 4-Year Mortality Risk Score 22 to identify a similar population. 23 Indeed, mortality risk scores alone can predict subsequent annual expenditures, representing a finding that is independent of actual mortality. 24 These data highlight the need for high-value health care delivery models to address both advanced medical illness and frailty that will extend well beyond the immediate postacute period, often for as long as several years.…”

Section: Preventable Hospital Readmissionsmentioning

confidence: 99%

“…The Mayo Clinic Palliative Care Homebound program exemplifies this construct and has demonstrated an $18,000 annual savings in a high-risk population defined by high utilization and mortality risk. 23 Other programs have demonstrated 63 Combining such programs with long-term services and supports (adult day care, home health aides, transportation, meals, and mobility equipment) can delay longterm care placement. 64 Hospital at Home, a home-based acutecare model, provided strong evidence of the reduction of preventable hospitalizations and also cost savings.…”

Section: Complementary Programsmentioning

confidence: 99%

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Hospital to Community Transitions for Older Adults

Takahashi

Leppin

Hanson

2020

Mayo Clinic Proceedings

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Spurred by changes in both population demographics and health care reimbursement, health care providers are responding by using new models to more fully support the posthospital transition. This paper reviews common models for posthospital transition and also describes the Mayo Clinic model for care transition. Models are designed with the intent of managing the cost of health care by reducing 30-day hospital readmissions and improving management of chronic disease. Meta-analyses have proved helpful in identifying the most effective program elements designed to reduce 30-day hospital readmissions. These elements include a bundled and multidisciplinary approach to best meet the needs of patients. Successful care teams also emphasize self-empowerment for both patients and caregivers. There are 2 general types of practice. In 1 model, introduced by Mary Naylor, an advancedpractice provider cares for the patient for a set period of time, which includes home visits. In the second model, introduced by Eric Coleman, a transitions coach, who can be an RN, a social worker, or a trained volunteer, serves as the health care coach, while improving self-efficacy. Both models have been successful. At Mayo Clinic, the Mayo Clinic Care Transitions program has encompassed a 7-year experience, using the services of an advanced practice provider. In previous studies, this model demonstrated a 20.1% (95% confidence interval [CI], 15.8 to 24.1%) decrease in 30-day readmission in controls compared with 12.4% (95% CI, 8.9 to 15.7%) in the control group. Although this model was successful in reducing 30-day readmissions, there was no difference between groups at 180 days. In patients experiencing the highest deciles of cost (8th decile), enrollment in a care transitions program reduced their overall cost by $2700. This cost savings was statistically significant. Both patients and caregivers participating in the program appreciated the home visits and felt more comfortable communicating at home.

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Section: Preventable Hospital Readmissionsmentioning

confidence: 99%

Section: Complementary Programsmentioning

confidence: 99%

Hospital to Community Transitions for Older Adults

Takahashi

Leppin

Hanson

2020

Mayo Clinic Proceedings

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“…Although a pattern of cost savings is seen, there is great heterogeneity among the population studied, including by age, diagnosis, prognosis, and the setting such as inpatient, home based, or hospice. 2 Other studies are often on a predominantly Medicare or elderly population [3][4][5][6][7][8][9][10][11][12] or focused on members in their last year of life. [3][4][5]7,8,13 Some studies may limit diagnoses to 3-6 different diagnoses, 4,9,12,14 with cancer, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) being the most frequently included.…”

Section: Introductionmentioning

confidence: 99%

“…2 Other studies are often on a predominantly Medicare or elderly population [3][4][5][6][7][8][9][10][11][12] or focused on members in their last year of life. [3][4][5]7,8,13 Some studies may limit diagnoses to 3-6 different diagnoses, 4,9,12,14 with cancer, congestive heart failure (CHF), and chronic obstructive pulmonary disease (COPD) being the most frequently included.…”

Section: Introductionmentioning

confidence: 99%

Home Palliative Care Savings

Gordon

Lee

et al. 2021

Journal of Palliative Medicine

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Objective: The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Study Design: Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. Methods: The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. Cost savings were further evaluated based on whether the member was enrolled in the palliative care program for 1-5 versus 6-12 months. Results: Overall medical costs for these 396 enrollees for the calendar year 2019 showed a gross savings of $24,643 per member (16.7% decrease in cost). For members enrolled for 1-5 months, annual gross savings were $23,314 per member (15.8% decrease from the comparison group), and for members enrolled for 6-12 months, annual gross savings were $26,409 per member (17.9% decrease). The savings were most prominent for the commercial insurance product with a 51% decrease in annual costs. Conclusions: Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6-12 months (17.9%) were greater than the gross savings for those enrolled for 1-5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product.

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“…Las herramientas de los sistemas de salud han mejorado cualitativamente y la sobrevida, en líneas generales, ha aumentado [5] ; sin embargo, la información sobre calidad de vida y calidad de fallecimiento de las personas con enfermedades crónicas, la infraestructura sanitaria y otros factores en el país son muy pobres [6] .…”

Section: Introductionunclassified

Las personas con enfermedad terminal y la necesidad de cuidados paliativos: una deuda pendiente de los servicios de salud

et al. 2019

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On top of all competences that a healthcare professional should have achieved during his/her training, palliative care is a growing need for patients from different age groups affected with cancer, cardiovascular diseases, degenerative conditions, and the like. Palliative care is a huge challenge for healthcare services, because this requires adequate teamwork, human resources and adequately functioning systems. Management, public health, service integration, ethical dilemmas, and ethical issues are the main barriers that physicians taking care of terminally ill patients must deal with. One of our main strategies for tackling this situation is to consolidate educational programs, so healthcare professionals may become empowered with knowledge; so, they may disclose the need for humanizing healthcare of terminally ill subjects.

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Improving Value of Care for Older Adults With Advanced Medical Illness and Functional Decline: Cost Analyses of a Home-Based Palliative Care Program

Abstract: The Mayo Clinic Palliative Care Homebound Program reduced annual Medicare expenditures by $18,251 per program participant compared with matched control patients. This supports the role of home-based palliative medicine in delivering high-value care to high-risk older adults.

Cited by 12 publications

References 21 publications

Hospital to Community Transitions for Older Adults

Hospital to Community Transitions for Older Adults

Home Palliative Care Savings

Las personas con enfermedad terminal y la necesidad de cuidados paliativos: una deuda pendiente de los servicios de salud

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