Health Plan Incentive Program to Improve Access to and Treatment of Palliative Appropriate Patients

Health plans utilize various strategies, including benefits, network design, incentive programs, payment reform, and medical policy, to enhance the quality of medical care for their members.

Determine the benefits of palliative care, particularly within the context of an incentive-driven program for a sicker Medicare Advantage (MA) population.

Retrospective cohort analysis to assess differences in outcomes between those receiving palliative care and a matched comparison. The sample consisted of Highmark MA members. The treatment group included members who had a palliative consultation during an inpatient admission, while the control group comprised members who had an eligible admission but did not receive a consultation. Patients were propensity score matched.

A total of 2095 matched Highmark MA members receiving care in the eastern United States between January 2020 and December 2023.

Claims-derived total cost of care was assessed using a difference-in-differences analysis. Process measures included the number of referrals to a community-based palliative care program.

The treatment group consistently had reduced costs relative to the matched controls (difference ranging from $4,485 to $4,827). Furthermore, referrals to community-based palliative care dramatically increased, with a 650% rise in 2022 and a 147% increase in 2023 compared to 2021.

These findings suggest that incentive-based programs, particularly when targeting sicker populations through redesigned eligibility, can effectively align financial incentives with improved palliative care delivery. This contributes to both significant cost-efficiency and enhanced patient care coordination, as evidenced by reduced costs and a substantial increase in palliative care referrals.