An original study recently appeared in the Journal of Pain and Symptom Management on the effects of primary care-led palliative care for Medicare patients in a value-based model. The study looked at 8 different primary care practices in New York, Pennsylvania, and Ohio, all owned by agilon health. It included 1,778 Medicare decedents who died between January 1, 2021, and January 31, 2023, and who had been enrolled in a palliative care program for at least 7 days. While each palliative care program was unique, all programs did include symptom management, goals of care/advance directive attention, primary care coordination, and assistance with the care transition if the patient enrolled in hospice. Some of the palliative care programs were owned by the primary care practices themselves, while other primary care practices contracted with third-party palliative care providers. The primary care practices were contracted at full risk with MA plans and with ACO REACH.
The results showed that substantially fewer patients that received palliative care died in the hospital – 9% vs. 26% – and spent an average of 5 more days at home. Total cost of care for the palliative care patients was $10,393 less per patient, which is a 33% decrease. The palliative care patients had fewer hospitalizations (0.57 vs. 0.94), emergency department visits (1.09 vs. 1.38), and ICU days (0.66 vs. 1.27). Again, these results were seen for non-hospice palliative care.
The authors of the study attributed much of these findings to better alignment of the care provided to the patients’ goals of care. They also call out that community-based, palliative care is very well suited to value-based care models where cost savings can be used to create robust and innovative palliative care programs that develop new care pathways for seriously ill, elderly patients. Importance was given to integration of the primary care provider who is to be held accountable for the quality and efficiency of care through an adaptable management process that can leverage robust, community-based palliative care provision. Meaningful, non-hospice palliative care is no longer being seen as an ancillary service, but as a necessary care model for effective value-based care for the seriously ill, and is best leveraged at the primary care level.
“Effects of Primary Care-Led, Integrated Palliative Care for Medicare Patients in a Value-Based Model” by Rao, K; Goldstein, NE; Peikes, DN; Polt, L; Komitzer, B; released on November 14, 2023, and available at https://www.jpsmjournal.com/article/S0885-3924%2823%2900779-0/fulltext