title: The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization.
abstract: People with advanced illness usually want their healthcare where they live-at home-not in the hospital. Innovative models of palliative care that better meet the needs of seriously ill people at lower cost should be explored.
  
  
  
  We evaluated the impact of a home-based palliative care (HBPC) program implemented within an Accountable Care Organization (ACO) on cost and resource utilization.
  
  
  
  This was a retrospective analysis to quantify cost savings associated with a HBPC program in a Medicare Shared Savings Program ACO where total cost of care is available. We studied 651 decedents; 82 enrolled in a HBPC program compared to 569 receiving usual care in three New York counties who died between October 1, 2014, and March 31, 2016. We also compared hospital admissions, ER visits, and hospice utilization rates in the final months of life.
  
  
  
  The cost per patient during the final three months of life was $12,000 lower with HBPC than with usual care ($20,420 vs. $32,420; p = 0.0002); largely driven by a 35% reduction in Medicare Part A ($16,892 vs. $26,171; p = 0.0037). HBPC also resulted in a 37% reduction in Medicare Part B in the final three months of life compared to usual care ($3,114 vs. $4,913; p = 0.0008). Hospital admissions were reduced by 34% in the final month of life for patients enrolled in HBPC. The number of admissions per 1000 beneficiaries per year was 3073 with HBPC and 4640 with usual care (p = 0.0221). HBPC resulted in a 35% increased hospice enrollment rate (p = 0.0005) and a 240% increased median hospice length of stay compared to usual care (34 days vs. 10 days; p < 0.0001).
  
  
  
  HBPC within an ACO was associated with significant cost savings, fewer hospitalizations, and increased hospice use in the final months of life.
authors: 1 Department of Palliative Care, ProHEALTH Care , Lake Success, New York.
authors: Dana
authors: D
authors: Lustbader
authors: 2 Optum Center for Palliative and Supportive Care , Eden Prairie, Minnesota.
authors: Mitchell
authors: M
authors: Mudra
authors: 3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
authors: Carole
authors: C
authors: Romano
authors: 3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
authors: Ed
authors: E
authors: Lukoski
authors: 3 ProHEALTH Medical Management, An Optum Company , Lake Success, New York.
authors: Andy
authors: A
authors: Chang
authors: 2 Optum Center for Palliative and Supportive Care , Eden Prairie, Minnesota.
authors: James
authors: J
authors: Mittelberger
authors: 4 Healthcare Analytics , OptumCare, Eden Prairie, Minnesota.
authors: Terry
authors: T
authors: Scherr
authors: 5 ProHEALTH Care , Lake Success, New York.
authors: David
authors: D
authors: Cooper
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics*; D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings / Q000379:methods*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006699:Home Care Services / Q000191:economics*; D006801:Humans; D008297:Male; D006278:Medicare / Q000191:economics*; D009518:New York; D010166:Palliative Care / Q000191:economics*; D011320:Primary Health Care / Q000191:economics*; D012189:Retrospective Studies; D014481:United States