Cost Reduction and Utilization Patterns in a Medicare Accountable Care Organization Using Home-Based Palliative Care Services.

Accountable care organizations (ACOs) are often tasked with helping providers to deliver care efficiently and with higher quality outcomes. For an ACO to succeed in delivering efficient care, it is important to direct resources toward patients who exhibit the greatest levels of opportunity while focusing attention toward mitigating their needs. Home-based palliative care (HBPC) services are known to address patient needs for those with serious illness while decreasing the total cost of care (TCC). In this retrospective review, ACO researchers reviewed cost, quality, and utilization patterns for 3418 beneficiaries within a Medicare Shared Saving Program approaching the end of life comparing decedents who received HBPC versus those who did not receive the service. Those individuals who received HBPC services were significantly less likely to be hospitalized (51% reduction in the HBPC group), more likely to use hospice (70% vs. 43%; P = 0.001), and their TCC was less than that of those who did not receive the service ($27,203 vs. $36,089: P = 0.0163). Although more research needs to be done to understand the specific components of care delivery that are helpful in decreasing unnecessary utilization, in this retrospective review in an accountable care population, HBPC is associated with a significant decrease in cost and utilization in a population approaching end of life.

Association Between Outpatient Rehabilitation Therapy and Total Cost of Care for a Frail Elderly Population in a Medicare Accountable Care Organization.

Frailty is a debilitating and increasingly costly condition in an elderly population equating to nearly $7.6 billion in Medicare spending in 2016. Understanding the burden of frailty and how to manage this population efficiently is of key importance in an accountable care organization. Using an operational, claims-derived definition of frailty, the authors set out to explore the association between therapy and total cost of care for the frail elderly population. Claims data were reviewed for nearly 94,000 beneficiaries to identify the burden of frailty in that population along with the association with therapy utilization. Nearly 10% of patients in the study populations were found to meet the operational definition of frailty. When the frail population is segmented into those who receive outpatient rehabilitation therapy and those who do not, outpatient rehabilitation therapy is associated with decreased cost at 13-32 therapy units delivered. Outside of this dose range, outpatient rehabilitation therapy was not associated with statistically significant improvements in total cost of care for this population. Results suggest that from the standpoint of population health management, utilization of outpatient rehabilitation services may be helpful to decrease costs in several domains. When that cost reduction is compared to therapy units delivered, it is demonstrated that outpatient rehabilitation therapy is associated with lower costs at a certain quantity of therapy. This study has implications for population health management of a frail elderly cohort as well as for managing preferred partnerships with therapy providers, given the wide array of therapy patterns delivered.