Department of Medical Affairs, Health Net, Inc., Cypress, California, USA.
Hospice and Palliative Care, LightBridge Hospice and Palliative Care, San Diego, California, USA.
J Palliat Med. 2022 Apr;25(4):591-595. doi: 10.1089/jpm.2021.0142. Epub 2021 Oct 8.
The aim of this study was to evaluate an adult home palliative care (HPC) program for multiple insurance product lines using multiple vendors to determine if the annual costs of health care decreased for those enrolled in HPC. Of the 506 members who were referred to and qualified for palliative care in 2019, a retroactive review was done comparing annual health care costs between the 396 members in the enrolled group and the 110 members in the group receiving usual care. The total health care costs for the calendar year 2019 were compared between the group enrolled in HPC and those who received usual care. Cost savings were further evaluated based on whether the member was enrolled in the palliative care program for 1-5 versus 6-12 months. Overall medical costs for these 396 enrollees for the calendar year 2019 showed a gross savings of $24,643 per member (16.7% decrease in cost). For members enrolled for 1-5 months, annual gross savings were $23,314 per member (15.8% decrease from the comparison group), and for members enrolled for 6-12 months, annual gross savings were $26,409 per member (17.9% decrease). The savings were most prominent for the commercial insurance product with a 51% decrease in annual costs. Adult home-based palliative care delivered by multiple vendors (consisting of multiple insurance product lines) to a population is effective in decreasing total medical costs by 16.7% during a calendar year compared with a control group. The gross savings for those enrolled for 6-12 months (17.9%) were greater than the gross savings for those enrolled for 1-5 months (15.8%). The savings were most prominent for the commercial insurance product, while an increase in cost was seen for the Medicaid product.
这项研究的目的是评估一个为多个保险产品线提供服务的成人家庭姑息治疗（HPC）项目，以确定参加 HPC 的患者的年度医疗费用是否降低。在 2019 年被推荐并符合姑息治疗条件的 506 名成员中，对参加 HPC 的 396 名成员和接受常规护理的 110 名成员的年度医疗费用进行了回溯性比较。将 2019 年的总医疗费用与参加 HPC 的患者和接受常规护理的患者进行比较。根据成员参加姑息治疗计划的时间（1-5 个月与 6-12 个月），进一步评估节省成本。对于这些 396 名参加者，2019 年的全年医疗费用显示，每位成员的总医疗费用节省了 24643 美元（成本降低 16.7%）。对于参加 1-5 个月的成员，每年的总节省额为 23314 美元（比对照组减少 15.8%），而参加 6-12 个月的成员，每年的总节省额为 26409 美元（减少 17.9%）。商业保险产品的成本降幅最大，为 51%。与对照组相比，由多个供应商（由多个保险产品线组成）为人群提供的基于家庭的成人姑息治疗在一年内有效降低了 16.7%的总医疗费用。参加 6-12 个月的成员的总节省额（17.9%）大于参加 1-5 个月的成员（15.8%）。商业保险产品的节省幅度最大，而医疗补助产品的成本则有所增加。
