Such palliative-care programs aim to provide assistance to
patients with chronic or terminal illnesses, and go beyond the drug
prescriptions and surgeries such patients typically receive. Under the programs,
doctors are often called in to prescribe drugs treating pain, anxiety and
depression, while home-care aides visit residences to give baths and change
sheets. Social workers may try to resolve conflicts between estranged siblings.
The programs have their critics, who say the insurers’ real goal
is to bolster profits by pushing patients to forgo costly treatments that could
prolong their lives. But supporters counter that the lowered costs are simply a
fortunate side effect, and that fulfilling patients’ wishes and needs is the main
“By improving quality of care for that group, it can also
reduce the number of repeat hospitalizations and other emergency interventions,
which is extremely expensive for payers,” says Emily Warner, a senior
policy analyst at the Center to Advance Palliative Care at the Icahn School of
Medicine at Mount Sinai.
In recent years, insurers including UnitedHealth Group’s Optum
unit and Highmark Inc. have created such programs—a trend that is likely to
continue as the population ages and efforts are made to both cut costs and
improve care for patients at the end of their lives.
Studies show that treatment of the most complex patients during
their final months accounts for a disproportionate amount of health-care
spending. About 25% of Medicare costs cover the last year of patients’ lives,
while 80% of the government health program’s spending during the last month is
for hospitalization. A visit to an intensive-care unit alone can cost more than
$4,000 a day.
Evidence suggests that the palliative-care programs can make a
major dent in those costs. Studies by Kaiser Permanente, for instance, found
that such programs can save $5,000 to $7,000 a patient by preventing costly
trips to emergency rooms and avoidable readmissions to hospitals. Aetna Inc.
says it saved $55 million in 2012 among its Medicare Advantage patients.
“If there is an opportunity to impact at the intersection of quality
and cost, this is the mother lode,” says Randall Krakauer, Aetna’s
director of medical strategy, who helped establish his company’s program.
Typical candidates for palliative care include patients suffering
from congestive heart failure, chronic obstructive pulmonary disease and
dementia. Many participants have cancer, typically at an advanced stage.
Dedicated teams of doctors, nurses, chaplains and social workers step in to interview
the patients to assess their needs and develop a plan for their extra care.
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