Past payment model demonstrations that included community-based palliative care offer a window into how these services could generate cost savings and improved quality.
Among those demos is the Medicare Care Choices Model (MCCM), which ran between 2016 and 2021.
The model illustrated palliative care’s potential for driving down health care costs for seriously ill patients, especially during the last 12 months of life, according to Dianne Munevar, vice president of health care strategy at NORC at the University of Chicago.
“The palliative care [components of] the MCCM program help solve for some of the high rates of hospitalizations and [emergency department (ED)] visits that are driving up costs in that last year of life,” Munevar said during a recent Congressional briefing. “One potential option to both onramp and provide a level of care that’s necessary at the end of life is community-based palliative care. Community-based palliative care has the potential to improve end-of-life care and Medicare program costs.”
Cost savings in MCCM
The MCCM demo found that access to community-based palliative care can significantly drive down hospitalizations and emergency department visits, as well as related costs..
An analysis from the U.S. Centers for Medicare & Medicaid Services (CMS) of the program found that palliative care achieved some of the largest cost-savings during the last year of life, Munevar said. Patients that utilized community-based palliative care services were more likely to enroll in hospice further upstream, she indicated.
“We found that there is another $500 million in potential savings for 346,000 potentially eligible enrolled beneficiaries,” Munevar stated. “There’s about a 20% efficacy rate for the community-based palliative care program on top of hospice, earlier in the home and enrollment in hospice.”
During its demonstration period, the MCCM model reduced total Medicare spending among beneficiaries served by 14%, with total savings per patient reaching $7,254, according to a Center for Medicare & Medicaid Innovation’s (CMMI) evaluation of the program.
Palliative care also decreased ED visits by 14% and inpatient admissions by 26% while boosting hospice enrollment by 29%.
“The [MCCM] we did was a palliative care model,” Ellen Lukens, deputy director of CMMI said at the Hospice News Palliative Care Conference. “It gives you a sense of the beneficiary continuum and how there needs to be different types of interventions and services related to value-based care. We don’t think we have all the answers, but we can look at all the data being collected from these models and [see] what happened in the model.”
Individuals living with serious illness utilize emergency care services at disproportionately higher rates than others, though many could benefit from community-based palliative care, according to a report from the Center to Advance Palliative Care (CAPC).
Where hospice fits in
Community-based palliative care services can also help eligible patients access hospice sooner, CAPC researchers indicated.
Community-based palliative care services have led to a 35% increase in hospice enrollment as well as a 240% rise in median hospice length of stay, the CAPC research found.
Lowering health care expenditures and improved hospice access were important pieces of the MCCM model, according to Davis Baird, director for government affairs for hospice at the National Association for Home Care & Hospice (NAHC).
Roughly 70% of cost savings that were derived from the MCCM model resulted from more timely care transitions to the hospice benefit, Baird said during the Capitol Hill briefing. The model demonstrated which reimbursement pieces are essential to include in a sustainable palliative care payment model, he stated.
“It’s a genesis for expansion in terms of improving or maintaining quality of care and driving savings in Medicare,” Baird said. “Testing the next generation of it that is more community-based, palliative care-like allows us to see what a sustainable payment and care model would do for this population. We also think it would most likely result in driving more timely access to hospice.”
