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Home-based palliative care helps ACOs manage fast-growing senior population with a serious or advanced illness, provide quality care, and generate cost savings that enable ongoing participation in the Medicare Shared Savings Program.
Amid growing pressure from CMS to take on additional risk, as a condition for ongoing participation, Medicare Shared Savings Program (MSSP) ACOs must contend with the rising cost of providing quality care while generating cost savings. This challenge is especially pronounced within the fast-growing senior population, the group most likely to experience a serious or advanced illness.
One-quarter of all Medicare dollars are spent on treatment during the final year of life. Moreover, one-third of the final-year expenditures are squeezed into the last month before death. Over that period, 80% of spending is for hospital-based treatment, much of it in intensive care units (ICUs). By 2050, the number of people on Medicare who are 80 and older will nearly triple, while the number of people in their 90s and 100s will quadruple. As a result, organi¬zational leaders are beginning to recognize that this fragile, vulnerable population requires a more focused approach to effectively address the enormity of the issues impacting cost and quality of care.
According to a recent study which looked at 2012 Medicare administrative claims data for older Medicare beneficiaries who died, researchers identified four unique spending trajectories:
- Nearly half (48.7%) of older Medicare beneficiaries were classified as “high persistent,” maintaining high spending throughout the year;
- 10.2% showed a “progressive” pattern, starting low but increasing steeply;
- 29.0% of decedents, were “moderate persistent,” mimicking the “high persistent” pattern except for a spending dip a few months prior to death;
- 12.1% of the sample exhibited a “late rise” in the final four months of life after very low spending in the earlier months of that final year.
Ironically, what has been the highest-cost population may now represent the greatest opportunity for ACOs to remain viable in the revised MSSP environment. Innovative models leveraging structured community-based palliative care deliver a high return on investment in both cost and quality. ACOs are discovering the benefits of moving patients with a serious or advanced illness out of the hospital and into the home environment.
Four necessary conditions to remain in the game
To deliver positive ROI in both cost and quality, any form of home-based palliative care strategy must be highly structured in its approach. ACOs must:
Identify. Engage. Support. Guide. None of these elements can be effective on their own and are only fully accretive when combined. However, there are specialized approaches that solve for this problem, virtually guaranteeing significantly positive ROI. ACOs choosing to stay in the MSSP program are faced not with whether to tackle end-of-life care and quality, but how.
Greer Myers is president of Turn-Key Health.