- Published in The American Journal of Managed Care -

Impact of Predictive Model-Directed End-of-Life Counseling for Medicare Beneficiaries

Author(s): Karen S. Hamlet, MA; Adam Hobgood, MS; Guy Brent Hamar, DDS, MPH; Angela C. Dobbs, MA; Elizabeth Y. Rula, PhD; and James E. Pope, MD

American Journal of Managed Care Objectives - To validate a predictive model for identifying Medicare beneficiaries who need end- of-life care planning and to determine the impact on cost and hospice care of a telephonic counseling program utilizing this predictive model in 2 Medicare Health Support (MHS) pilots.

Study Design - Secondary analysis of data from 2 MHS pilot programs that used a randomized controlled design.

Methods - A predictive model was developed using intervention group data (N = 43,497) to identify individuals at greatest risk of death. Model output guided delivery of a telephonic intervention designed to support educated end-of-life decisions and improve end-of-life provisions. Control group participants received usual care. As a primary outcome, Medicare costs in the last 6 months of life were compared between intervention group decedents (n = 3112) and control group decedents (n = 1630). Hospice admission rates and duration of hospice care were compared as secondary measures.

Results - The predictive model was highly accurate, and more than 80% of intervention group decedents were contacted during the 12 months before death. Average Medicare costs were $1913 lower for intervention group decedents compared with control group decedents in the last 6 months of life (P = .05), for a total savings of $5.95 million. There were no significant changes in hospice admissions or mean duration of hospice care.

Conclusions - Telephonic end-of-life counseling provided as an ancillary Medicare service, guided by a predictive model, can reach a majority of individuals needing support and can reduce costs by facilitating voluntary election of less intensive care.

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Topics: Health Conditions Older Populations Performance/Productivity Peer Reviewed Health Plan & Health System Medical Costs & Utilization Predictive Modeling