Care Transformation in Palliative Care: Leveraging a Payor-Provider Partnership to Fast-track Growth of a Palliative Program

Abstract

Background:

High-quality end-of-life care has the potential to improve clinical outcomes and reduce costs but is underutilized in the United States.

Objectives:

This study describes a unique partnership between an insurer and a provider to enhance the quality, availability, and access to palliative services.

Design:

A retrospective cohort analysis of insurance claims data for patients receiving palliative care compared to a matched cohort not receiving palliative care services from 2019 through 2022. Using difference-in-differences with paired t-tests, the relationship between palliative care and health care outcomes was determined.

Participants and Setting:

Highmark Medicare Advantage members in the United States, with 614 members in the treatment group matched with 614 in the control group.

Results:

Outcomes demonstrated a total savings of $4,526,408 through reductions in costs for the treatment group compared to the control group for total cost of care ($7,160, p < 0.001), inpatient stays ($5,672, p < 0.001), outpatient visits ($229, p = 0.010), professional claims ($1,243, p < 0.001), and pharmacy fills ($17, p = 0.010). The treatment group had lower skilled nursing facility ($1,049, p < 0.001) and inpatient rehabilitation facility ($216, p = 0.015) costs. The treatment group had higher rates of hospice care (83.7% in the treatment compared to 50.2%, p = 0.002) but had lower lengths of stay (four days compared to five, p < 0.001).

Conclusions:

Collaborative investment in a palliative program by a payor and provider system shows significant financial savings for an insurer when patients receive evidence-based palliative care near the end of life.