A Value-Based Payment Model for Palliative Care: An Analysis of Savings and Return on Investment

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%...

Full description

Saved in:
Bibliographic Details
Published inThe Journal of ambulatory care management Vol. 42; no. 1; p. 66
Main Authors Bernstein, Richard H, Singh, Laura A
Format Journal Article
LanguageEnglish
Published United States 01.01.2019
Subjects
Aged
Community Health Services - economics
Health Care Costs
Health Care Reform
Health Services Accessibility
Humans
Medicare Part C - economics
Models, Economic
Palliative Care - economics
United States
Value-Based Purchasing
United States
Online AccessGet more information

Cover

More Information
Summary: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.
ISSN:1550-3267
DOI:10.1097/JAC.0000000000000259