Economic Impact of an Advanced Illness Consultation Program within a Medicare Advantage Plan Population

Background: In the United States the quality and cost associated with medical treatment for individuals experiencing an advanced illness is highly variable and is often misaligned with the patient's and family's quality of life values and priorities. Many of the obstacles that stand in the way of aligning the care that an individual receives with their priorities are well understood in the context of behavioral science. Through employing behavioral based approaches to improve the quality of communication and shared decision making processes among patients, providers and families it is possible to enhance the efficiency of delivering care which is also more highly aligned with the individual's preferences. Objectives: The study objectives were to measure the economic impact of a proprietary advanced illness behavioral consultation program, the Vital Decisions Living Well Consultation Program (LWCP), on the cost of care delivered during the last six and three months of life for enrolled members in a Medicare Advantage plan. Study design: Retrospective matched case control analysis examined medical, pharmaceutical, and capitation expenses after an offset by premium revenue. Methods: The treatment population consisted of participating members of the LWCP who died between October 1, 2011 and March 31, 2013 (N = 1755). The control population consisted of plan members who died between July 1, 2008 and June 1, 2011, prior to the introduction of the LWCP (N = 5560). Criteria used to match treatment subjects with one or more control subjects were diagnosis, age at death, and health care costs incurred prior to the time under examination. A paired t-test evaluated the significance of differences between the matched treatment and control members. Results: The mean cost reduction during the last six months of life for treatment members compared to matched control group members was $13,956 (p < 0.001) during the last six months of life and $9,285 (p < 0.001) during the last three months of life. Conclusion: Members with advanced illness who participated in LWCP had significantly lower end-of-life (EOL) spending compared to matched members who did not participate in the program.