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While it is well accepted that non-hospice palliative care (PC) provides a tool to favorably impact utilization, cost, and quality, we are now at the point that we need to dive into the details and test any assumptions that we may hold. In a recent study published in the Journal of Palliative Medicine, great scrutiny was paid to the nuances of pulling apart cause from effect.
Other studies on the impact of non-hospice, home-based PC have shown that a decrease in utilization and cost after a PC intervention was introduced. However, was this caused by the PC intervention or due to normal regression to the mean after a medical crisis? In other words, after a medical crisis and the ensuing increase in interventions, patients usually stabilize, and their utilization and costs naturally decrease when compared to when they were in crisis. At the same time, PC services are often offered at this time – when the medical crisis is over and the patient begins to stabilize and more forward. So, is the decrease in utilization and spend due to the PC intervention or to natural regression? This study did a great job of matching the intervention group to the “control” group when reviewing claims histories for a health plan funded, home-based PC program in California. For both groups, utilization and cost did decrease and, while the decrease was greater for the group receiving PC, the difference was not statistically significant, though the difference was increasing, and the researchers felt the difference would have reached a level of significance if the investigation period was extended. The PC intervention group did show a significant increase in length of stay in the study, implying that those patients lived longer and/or transitioned to hospice later.
It is vital that innovation and interventions are undertaken with solid understanding and evidence of what is at play. Seeing PC as a magical panacea can create false expectations, setting up PC providers to disappoint or fail. Further analysis leads to a deeper understanding. Specifically, this study does show that PC intervention – while not increasing cost and perhaps lowering it – did decrease mortality for patients (which is the measure of success for almost all other clinical interventions) while improving pain and symptom management and quality of life. A realistic understanding of value is incredibly powerful.
Source Material:
“Cost and Utilization Implications of a Health Plan’s Home-Based Palliative Care Program” by Bower, KA; Hallock, J; Li, X; Kent, T; and Wardlow, L; released on January 25, 2024, by Journal of Palliative Medicine, and available at https://www.liebertpub.com/doi/full/10.1089/jpm.2023.0401?af=R
