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Related Experiment Videos

A Large-Scale Advanced Illness Intervention Informs Medicare's New Serious Illness Payment Model.

Brad Stuart1, Elizabeth Mahler2, Praba Koomson3

  • 1Brad Stuart ( BradS@theCTAC.org ) is the chief medical officer at the Coalition to Transform Advanced Care, in Washington, D.C.

Health Affairs (Project Hope)
|June 4, 2019
PubMed
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A home-based care intervention for seriously ill patients significantly reduced hospitalizations and costs. This model is influencing new Medicare payment strategies for advanced illness care.

Area of Science:

  • Health Services Research
  • Gerontology
  • Palliative Care

Background:

  • Fragmented, hospital-centered care for advanced illness often misaligns with patient end-of-life preferences.
  • Existing care models struggle to provide coordinated, patient-centered support for seriously ill individuals.

Purpose of the Study:

  • To describe a team-based, home-based intervention for seriously ill patients.
  • To evaluate the impact of this intervention on healthcare utilization and costs.
  • To share lessons learned for developing new payment and quality models for serious illness care.

Main Methods:

  • A prospective, team-based intervention delivering coordinated, home-based care to over 2,000 seriously ill patients daily.
  • Comparison with matched Medicare beneficiaries in similar geographic areas.
Keywords:
AIMAdvanced Illness ManagementAdvanced illnessEnd of life careHome-based palliative carehome-based carepalliative care

Related Experiment Videos

  • Analysis of hospital days, deaths, inpatient payments, and total cost of care in the last month of life.

    • Main Results:

    • Reduced hospital days by 1,361 per 1,000 beneficiaries.
    • Decreased hospital deaths by 8.2% compared to matched controls.
    • Lowered inpatient payments by $6,127 and total cost of care by $5,657 per beneficiary.

    Conclusions:

    • Home-based, coordinated care models can significantly improve outcomes and reduce costs for seriously ill patients.
    • Lessons learned from this intervention are informing the development of new Medicare payment models for serious illness.
    • Shifting care focus from hospital to home requires integrated coordination, new payment structures, and accountability for quality outcomes.