A community-based palliative care program reduced medical costs, intensive care unit (ICU) admissions, hospital admissions, and days spent in the hospital for Medicare Advantage members with serious illness.

Background

Using data analytics, population health models identify patients based on care needs and deploy interdisciplinary teams. This study evaluated a community-based palliative care program in Ohio that used a population health model to identify patients’ needs, tailor interventions, and determine potential clinical and cost benefits among Medicare Advantage members.

Findings

Medicare Advantage health plan members who received community-based palliative care from program nurses and social workers had significantly lower costs and critical care utilization compared to a matched control group that received standard health plan case management. The program led to a 20% reduction in total medical costs, 38% reduction in ICU admissions, 33% reduction in hospital admissions, and 12% reduction in hospital days.

Program/Policy Takeaways

A structured nurse and social work model, paired with predictive analytics, helped direct resources to high-need populations, reduce avoidable health care utilization, and save costs. The partnership featured in this article can help inform health plans and providers seeking to implement a population health model for their community-based palliative care program.