Expanding Palliative Medicine across Care Settings: One Health System Experience.

BACKGROUND: The success of our hospital-based Palliative Care program stimulated requests to duplicate the program across the health system continuum of care. OBJECTIVE: To develop a model of care focused on a high-need, high-cost population that could be implemented across all care settings, including hospitals and patients' homes. METHODS: To fiscally support program expansion from hospital to home, we conducted a retrospective cost analysis for home-based Palliative Care (HBPC)-enrolled patients with continuous claims months before program enrollment through date of death. The HBPC enrollees were evaluated against a cohort group of CMS (Centers for Medicare & Medicaid Service) and Medicare Advantage patients who did not participate in the HBPC program (n = 3135). Twenty-one months of claims leading up to the date of death were evaluated for both populations. The analysis was designed to test whether Palliative Care patients demonstrated less overall claims expense and service utilization in the same periods as patients without Palliative Care. Claim months were grouped into three-month clusters for evaluation and statistical testing of per member per month utilization and cost. RESULTS: Overall, HBPC patients demonstrated significantly less service utilization and cost in the months leading up to death. Cost differences were primarily driven by clear cost divergence in the last three months of life [$9,843 (PC) vs. $27,530 (C)]. Our program grew from a hospital-based program to include the establishment of a home-based program. CONCLUSION: Palliative Care programs can successfully expand outside hospital walls to serve a high need/high-cost patient population.

Duke Scholars

Author Christopher Jones Medicine, General Internal Medicine

Author Arif H Kamal Medicine, Medical Oncology