Blog Post | May 16, 2019

Positive Results and Cost Benefits of a Population Health Community-Based Palliative Care Program


We’re excited to announce the publication of an eight-month pilot study in this prestigious, peer-reviewed Journal of Palliative Medicine.

“ Effects of a Population Health Community-Based Palliative Care Program on Cost and Utilizationappears in the April 5, 2019, issue and reports the positive results of Turn-Key’s  Community-Based Palliative Care Program (CBPC) solution delivered to members of a Medicare Advantage Plan from its program with Trinity Health System:

  • Lower total healthcare costs
  • Decreased hospitalizations and ICU days
  • Increased hospice utilization while improving care quality and member satisfaction

Authored by Lori Yosick, Robert E. Crook, Maria Gatto, Terri L. Maxwell, Ian Duncan, Tamim Ahmed, and Andrew Mackenzie, the study included members of the MA plan who were proactively identified for the program by Turn-Key Health’s predictive model.  Care was provided by specially trained palliative nurses and social workers from Mount Carmel Hospice and Palliative Care guided by Turn-Key Health’s platform, assessments and workflows.

Impressive Results

The prospective study — focused on a 30,000-member Medicare Advantage plan and a health system in Central Ohio between October 2015 and June 2016 — yielded impressive results:

  • 20 percent reduction in total medical costs ($619 per enrolled member per month)
  • 38 percent reduction in ICU admissions
  • 33 percent reduction in hospital admissions
  • 12 percent reduction in hospital days

Study co-author Terri Maxwell, PhD, APRN, chief clinical officer, Turn-Key Health, explains, “The Turn-Key palliative care team focused on helping patients and their families integrate health and social services to support independence at home and reduce caregiver burden. They provided medication and disease-specific education, elicited and clarified goals of care, assisted in completion of advance care plans and facilitated shared decision making. Doing so resulted in earlier election of hospice and lower rates of acute care utilization.”

Researchers concluded that care that is primarily driven by values, goals, and preferences of seriously ill individuals and their family members results in more compassionate, affordable, sustainable, and high-quality care.

Structured Engagement

The Mount Carmel team utilized Turn-Key Health’s evidence-based palliative care assessment tools and care paths that determined visit frequency and type (phone vs. home visits) supported by real-time clinical dashboards and a mobile platform.

They then developed a patient-centered palliative care plan for each patient enrolled in the program, outlining the patient and family’s goals, strengths, needs and preferences, as well as specific services and supports that the team arranged to help the patient avoid unplanned care and make informed care decisions. Additionally, they coordinated services with the patient’s health plan case manager and contacted the patient’s physician for any medical related needs.

Patient Identification

Researchers report that in addition to the structured care model as described, what differentiates this program from others is the way that patients are identified:  moving from the traditional referral model to one that utilizes predictive analytics and a proprietary algorithm to identify members earlier in their disease trajectory and are appropriate for outreach and enrollment.

This approach does not simply predict mortality – it identifies those at risk for overmedicalized death in the next 6-12 monthsThese are members who are likely to use inpatient care and consume considerable medical services during their final months of life.

Overmedicalized death is defined as one or more of the following documented in the patient’s record at the time of death:

  • Chemotherapy for cancer patients within 28 days of death
  • Unplanned hospitalization within 60 days of death
  • More than one emergency department (ED) visit within 30 days of death
  • ICU admission within 30 days of death
  • Life-sustaining treatment within 30 days of death

Higher Quality Care at Reduced Costs

Authors point out that as the U.S. health care system moves toward value-based payment models, MA and other health plans are incentivized to provide higher quality care at a reduced cost by eliminating nonbeneficial and wasteful care.

They also assert that community-based palliative care programs are associated with decreased hospitalizations and costs in the last months of life, noting that this study included persons still living during the study period and whose costs are expected to rise in the months preceding death.

“Hospice was introduced earlier and resulted in longer length of stay in hospice — an important quality marker,” reports the researchers.  “This study’s short program duration and prospective nature explain the relatively low hospice conversion rate.  These patients’ illnesses are likely to progress the longer they are in the program such that they eventually meet the eligibility requirements for hospice.”

Acknowledgment

This program and study were funded by an innovation grant from Trinity Health Plan.

Presented as a poster at CAPC Annual Conference, Orlando Florida, November 2016 and AAHPM Annual Conference, Phoenix, Arizona, February 2017.

Author Disclosure Statement

No competing financial interests exist.

IRB approval was obtained from the Mount Carmel Health System IRB.

To learn more, click here to read the article.


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