The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

Abstract

Background: People with advanced illness usually want their healthcare where they live—at home—not in the hospital. Innovative models of palliative care that better meet the needs of seriously ill people at lower cost should be explored.Objectives: We evaluated the impact of a home-based palliative care (HBPC) program implemented within an Accountable Care Organization (ACO) on cost and resource utilization.Methods: This was a retrospective analysis to quantify cost savings associated with a HBPC program in a Medicare Shared Savings Program ACO where total cost of care is available. We studied 651 decedents; 82 enrolled in a HBPC program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. We also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.Results: The cost per patient during the final three months of life was $12,000 lower with HBPC than with usual care ($20,420 vs. $32,420; p = 0.0002); largely driven by a 35% reduction in Medicare Part A ($16,892 vs. $26,171; p = 0.0037). HBPC also resulted in a 37% reduction in Medicare Part B in the final three months of life compared to usual care ($3,114 vs. $4,913; p = 0.0008). Hospital admissions were reduced by 34% in the final month of life for patients enrolled in HBPC. The number of admissions per 1000 beneficiaries per year was 3073 with HBPC and 4640 with usual care (p = 0.0221). HBPC resulted in a 35% increased hospice enrollment rate (p = 0.0005) and a 240% increased median hospice length of stay compared to usual care (34 days vs. 10 days; p < 0.0001).Conclusion: HBPC within an ACO was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life.

A National Profile Of End-Of-Life Caregiving In The United States

“…Although not universally accessible, palliative care programs that focus on improving quality of life for patients and their families are increasingly available within large hospitals, 25 and are expanding to long-term care 26 and community-based settings. 27 A better understanding of the nature and intensity of EOL caregiving could prove useful to ongoing efforts to monitor and improve access and quality of hospice and palliative care.…”

Accountability for the Quality of Care Provided to People with Serious Illness

“…17 More recent studies have shown financial benefits from community-based serious illness care. Lustbader et al 18 found that home-based palliative care provided to patients in an ACO was associated with cost savings, reduced hospitalization, and increased hospice use. Another study compared the impact of three community-based oncology care programs that used different models to reduce cost and improve quality of life.…”

Palliative care and intensive care integration

“…If the process is irreversible in terminal stage patients in ICU, the advances in ICU treatments together with technological developments lead to an increase in severe sequelae in patients by prolonging the process of death [6]. Although there has been an increase in recent years in the delivery of PC services to patients in hospital or care provided at home, it is not clear whether these services have met the PC requirements of these patients and their families [14][15][16].…”