TY - JOUR
T1 - A Value-Based Payment Model for Palliative Care
T2 - An Analysis of Savings and Return on Investment
AU - Bernstein, Richard H.
AU - Singh, Laura A.
N1 - Funding Information:
While palliative care is often reimbursed on a monthly case rate when it is part of a hospice program, clinicians in a hospital and the community are typically paid on a fee-for-service basis. Quality palliative care requires financial support of ICT members (eg, nurses and social workers). This can be subsidized under an institution budget in a hospital, hospice, or health plan-affiliated program. In the ambulatory setting, where nonhospice palliative care is often delivered in the home, programs require subsidization by an affiliated hospital, philanthropy, or other less dependable sources of support since insurance does not pay for ICT members and program overhead.
Publisher Copyright:
© 2019 Wolters Kluwer Health, Inc.
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Five percent of the US population accounts for 50% of total health expenditures. This "5%" problem requires moderating Medicare cost trends. SPARK, a community-based palliative care program, focused on its costliest Medicare Advantage patients. This cohort's projected costs were 280% higher than average beneficiaries, based on Medicare's risk model. Despite significant losses during enrollees' first year, a positive 5.1% ROI was found over the program's 4 years when stop-loss insurance payments were included. SPARK demonstrates that a high-quality, community-based palliative care program can be financially self-sustaining using a value-based payment model with premium plus stop-loss income exceeding actual costs.
AB - Five percent of the US population accounts for 50% of total health expenditures. This "5%" problem requires moderating Medicare cost trends. SPARK, a community-based palliative care program, focused on its costliest Medicare Advantage patients. This cohort's projected costs were 280% higher than average beneficiaries, based on Medicare's risk model. Despite significant losses during enrollees' first year, a positive 5.1% ROI was found over the program's 4 years when stop-loss insurance payments were included. SPARK demonstrates that a high-quality, community-based palliative care program can be financially self-sustaining using a value-based payment model with premium plus stop-loss income exceeding actual costs.
KW - CMS-HCC risk adjustment model
KW - community-based palliative care
KW - return on investment
KW - stop-loss insurance
KW - value-based payment
UR - http://www.scopus.com/inward/record.url?scp=85057558734&partnerID=8YFLogxK
U2 - 10.1097/JAC.0000000000000259
DO - 10.1097/JAC.0000000000000259
M3 - Article
C2 - 30499902
AN - SCOPUS:85057558734
SN - 0148-9917
VL - 42
SP - 66
EP - 73
JO - Journal of Ambulatory Care Management
JF - Journal of Ambulatory Care Management
IS - 1
ER -