title: Avoiding Spending While Meeting Patients' Wishes: A Model of Community-Based Palliative Care Uptake in California from 2014-2022.
abstract: BACKGROUND
  Community-based palliative care can improve outcomes and avoid unnecessary spending, but the effects of its widespread adoption on health care spending in California is unknown.
  
  
  OBJECTIVE
  To estimate the spending avoided if, by 2022, more than 100,000 Californians received community-based palliative care (CBPC) per year.
  
  
  METHODS
  We estimated the 6-month per-patient spending avoided through three mature CBPC programs in California and extrapolated data to predict the total avoided spending statewide over 8 years if enrollment in the three programs proceeded according to our model.
  
  
  RESULTS
  If Californians participated in CBPC in the numbers envisioned, in 2014 there would have been a $72 million reduction in intensive hospital based care, while still respecting patients' wishes, and nearly $1.1 billion in spending could be avoided in 2022. Overall hospital spending would be reduced by more than $5.5 billion through 2022.
  
  
  CONCLUSIONS
  Existing CBPC programs have the potential to provide care that is both in alignment with patients' wishes and avoids substantial amounts of unnecessary hospital-based spending.
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California , Berkeley, Berkeley, California.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Kessell
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California , Berkeley, Berkeley, California.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Scheffler
authors.affiliation: Division of Health Policy and Management, School of Public Health, University of California , Berkeley, Berkeley, California.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Shortell
mesh_terms: D002140:California; D003153:Community Health Services / Q000191:economics* / Q000639:trends*; D017046:Cost Savings / Q000706:statistics & numerical data; D005544:Forecasting; D005102:Health Expenditures / Q000706:statistics & numerical data* / Q000639:trends*; D006801:Humans; D010166:Palliative Care / Q000191:economics* / Q000639:trends*; D057240:Patient Preference / Q000191:economics*