title: Impact of predictive model-directed end-of-life counseling for Medicare beneficiaries.
abstract: OBJECTIVE
  To validate a predictive model for identifying Medicare beneficiaries who need end-of-life care planning and to determine the impact on cost and hospice care of a telephonic counseling program utilizing this predictive model in 2 Medicare Health Support (MHS) pilots.
  
  
  METHODS
  Secondary analysis of data from 2 MHS pilot programs that used a randomized controlled design.
  
  
  METHODS
  A predictive model was developed using intervention group data (N = 43,497) to identify individuals at greatest risk of death. Model output guided delivery of a telephonic intervention designed to support educated end-of-life decisions and improve end-of-life provisions. Control group participants received usual care. As a primary outcome, Medicare costs in the last 6 months of life were compared between intervention group decedents (n = 3112) and control group decedents (n = 1630). Hospice admission rates and duration of hospice care were compared as secondary measures.
  
  
  RESULTS
  The predictive model was highly accurate, and more than 80% of intervention group decedents were contacted during the 12 months before death. Average Medicare costs were $1913 lower for intervention group decedents compared with control group decedents in the last 6 months of life (P = .05), for a total savings of $5.95 million. There were no significant changes in hospice admissions or mean duration of hospice care.
  
  
  CONCLUSIONS
  Telephonic end-of-life counseling provided as an ancillary Medicare service, guided by a predictive model, can reach a majority of individuals needing support and can reduce costs by facilitating voluntary election of less intensive care.
authors.affiliation: Center for Health Research, Healthways, Inc, 701 Cool Springs Blvd, Franklin, TN 37067, USA.
authors.forename: Karen S
authors.initials: KS
authors.lastname: Hamlet
authors.forename: Adam
authors.initials: A
authors.lastname: Hobgood
authors.forename: Guy Brent
authors.initials: GB
authors.lastname: Hamar
authors.forename: Angela C
authors.initials: AC
authors.lastname: Dobbs
authors.forename: Elizabeth Y
authors.initials: EY
authors.lastname: Rula
authors.forename: James E
authors.initials: JE
authors.lastname: Pope
mesh_terms: D003365:Costs and Cost Analysis; D003376:Counseling / Q000191:economics*; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D006278:Medicare; D008962:Models, Theoretical; D015397:Program Evaluation; D013689:Telephone; D013727:Terminal Care; D014481:United States