Aetna's Compassionate Care Program: Sustained Value for Our Members with Advanced Illness

Area of Science:

• Health Services Research
• Palliative Care
• Health Insurance Programs

Background:

• Aetna launched the Aetna Compassionate Care Program (ACCP) in 2004 to enhance palliative and hospice care access for advanced illness members.
• Evaluating the ACCP's impact on healthcare utilization and hospice enrollment is crucial for understanding its effectiveness.

Purpose of the Study:

• To assess the effect of the Aetna Compassionate Care Program (ACCP) on healthcare utilization and hospice enrollment among its members.
• To analyze changes in hospice use, medical costs, and healthcare visits in the final 90 days of life for ACCP participants versus a control group.

Main Methods:

• Retrospective cohort study comparing ACCP participants with a matched control group using propensity score methodology.
• Analysis included Aetna Medicare Advantage members enrolled in ACCP between January 2014 and June 2015.
• Primary outcomes measured hospice enrollment rates, days in hospice, and healthcare utilization (inpatient admissions, ER, primary/specialty care visits) and associated costs in the 30 and 90 days preceding death.

Main Results:

• ACCP participants showed a 36% higher likelihood of hospice enrollment (79% vs. 58%, p < 0.0001).
• Acute inpatient medical costs were reduced in the last 90 days of life for ACCP members ($4169 vs. $5863, p < 0.0001).
• This cost reduction was primarily due to fewer inpatient admissions (860 vs. 1017, p < 0.0001) among ACCP participants.

Conclusions:

• Advanced illness case management programs, like ACCP, effectively improve access to hospice services.
• These programs can enhance patient outcomes and reduce unnecessary hospital admissions during the critical final 90 days of life.
• The ACCP demonstrates a successful model for integrating palliative and hospice care within a national health insurance framework.