Leading California Health Plan Demonstrate Positive Return on Investment with Home-Based Palliative Care

In the January 2024 issue of the Journal of Palliative Medicine, leadership from Blue Shield of CA and researchers from West Health Research Institute found that home-based palliative care delivered to people not yet eligible for hospice, reduced hospitalizations, increased length of life, and extended the continuum of care delivered at home for people with serious illness and their caregivers.

The study included home-based palliative care providers who delivered care as part of their home health and hospice agency services and were contracted with the health plan, reimbursed through a monthly bundled payment rate for each beneficiary enrolled. To be part of the contracted network, providers were required to demonstrate that they could deliver services through an interdisciplinary team, including medical doctors, nurse practitioners, nurses, social workers, and chaplains, ensuring that these services be available 24/7 at least through a dedicated phone line for support. Services included pain and symptom management, disease management and education, care coordination, advance care planning, and bereavement support. Care teams were required to manage a plan of care for each patient and to provide in-person visits at least once every 3 months or whenever there was a significant change to the person’s goals for care. These services are aligned with C-TAC’s Core Principles of Care for people with serious illness and recommendations by the Center to Advance Palliative Care (CAPC).

During the study period (2017-2019), the health plan enrolled more than 2,000 people with serious illness across their commercially insured and Medicare Advantage plans, including those who received care through contracted Accountable Care Organizations (ACO’s) across the state. Enrolled patients were matched with those in a control group of over 50,000 patients with a similar disease profile but who did not receive palliative care services during the study period. Researchers evaluated the results based on the following outcomes: inpatient and emergency department costs; emergency department utilization; hospital utilization; mortality.

Cost and utilization were not captured for those beneficiaries who received palliative care services in their final six months of life, which is often where costs and utilization increases for people with serious illness.

According to the research, “if the last six months of life had been captured for more study participants, a greater impact of the program may have been demonstrated. The fact that so few members died during the study period suggests that the members were receiving upstream palliative care.”

Those who received home-based palliative care services demonstrated fewer emergency department visits, fewer hospitalizations, and lower costs once they started receiving palliative care services than prior to enrollment, demonstrating that palliative care may be an effective alternative to unnecessary and often unwanted emergency room visits and hospitalizations. Those who received palliative care services during the study period demonstrated a trend toward living longer than those who did not receive palliative care services, but more evidence is needed. The study did not include measures related to quality of care and patient quality-of- life, which palliative care services have been proven to impact.

This most recent example of the impact of home-based palliative care services only demonstrates that health plans and other payors can increase access to palliative care services for people with serious illness without a significant impact on cost of care, creating increased access to high-quality care for their beneficiaries and a higher quality-of-life for people with serious illness and their caregivers.