Organizations are experimenting with population health principles to engage patients further upstream and move them into hospice earlier, if appropriate and concordant with the patient’s wishes and goals. This can contribute to improved quality of life for patients as well as cost savings for health care providers.
Population health is in most contexts a term used to describe the health outcomes of a group of individuals, including the distribution of such outcomes within the group, according to the University of Wisconsin’s Department of Population Health Sciences. Such groups can consist of the population of a certain geographic area, a demographic, or a group of particular types of patients, such as cancer patients or patients enrolled in hospice.
“A lot of what we do is focused on ways we can identify patients who have potentially over-utilized a [health care] service or where we can improve quality and reduce cost. That’s a lot of what population health is about in the broader sense,” said Ian Duncan, an actuary and adjunct professor in the Department of Statistics & Applied Probability at the University of California Santa Barbara. “The opportunity to both improve the quality of the last period of somebody’s life as well as to reduce the spend is something that payers and health care providers are interested in. [Population health modeling] is helpful in identifying potential candidates for having that discussion.”
While hospice utilization is rising, lengths of stay for many patients remains too short for them to receive the full benefit of hospice care. Hospice utilization among Medicare decedents exceeded 50% for the first time in 2018, according to the National Hospice & Palliative Care Organization (NHPCO). More than 27% of patients in 2017, however, were in hospice for seven days or less, with another 12.7% in hospice for less than 14 days, NHPCO reported.
The No. 1 complaint that families report on hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys is that they wish their loved one had entered hospice sooner, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
“One thing population health does really well is to think ahead about the needs of patients and put the right resources in place to meet those needs, including complex, high-risk patients,” said Rachelle Bernacki, M.D., medical director for the Center for Geriatric Surgery at Brigham and Women’s Hospital. “The main way that population health can help with hospice is identifying patients so they can have that conversation early. I think for hospices reaching out to high-risk-care case management programs and letting them know that they’re available will make it easier for them. If they see people earlier the families are more satisfied, staff are more satisfied, and patients get better care. There’s opportunities to form more partnerships in that way.”
Application of population health principles to palliative and hospice care through the use of predictive models can improve the quality of care, reduce hospitalizations and slash health care costs.
A Sept. 2019 study in the Journal of Palliative Medicine followed 204 members of a Medicare Advantage plan in an Ohio health system who were enrolled in a community-based palliative care program. Duncan was among the researchers who conducted this study.
The patients, who were identified through population health analytics, saw a 20% reduction in total medical costs, nearly 40% reduction in intensive care unit admissions, a 33% drop in hospital admissions, and 12% reduction in hospital lengths of stay.
A number of payers are interested in working with hospice and palliative care providers to use analytics based on population health models to identify patients in need of their services.
“The payers recognize that relationship between the potential cost of the population and the fact that palliative care is less expensive than intensive care, and therefore there is support. There’s both an improvement in living status as well as the reduction in the payer cost,” Duncan told Hospice News. “There really is a potential for improving quality of life. Identification is always the first level, using statistical modeling based on the data we have available, which is primarily medical claims. Then there is always the clinician involvement to begin work with the patient and family to discover whether they are in fact appropriate candidates for palliative care or hospice.”