Impact of Outpatient Palliative Care Services on Resource Utilization and Cost Management in a Capitated Medicare Population.

Abstract

Objective: The integration of palliative care into the U.S. health care system has grown significantly, with outpatient palliative care services (OPCSs) playing an increasingly vital role in managing patients with serious illnesses. This study evaluates the impact of OPCS on resource utilization and cost management within the MemorialCare Medical Group Medicare Advantage population from January 1, 2019, to December 31, 2023. Design: The analysis focuses on cost reduction, emergency department (ED) visits, inpatient (IP) admissions, and average length of stay. Results: Results demonstrate substantial growth in OPCS enrollment, with a 129% increase from 2019 to 2023. Per-member-per-month costs showed a sustained reduction, with a 23% decrease by 2023. In addition, there were consistent reductions in ED visits and IP admissions, indicating effective outpatient care management. Patients transitioning from OPCS to hospice exhibited longer hospice stays, further emphasizing the benefits of early palliative care interventions. Conclusion: These findings underscore the potential of OPCS to enhance patient outcomes, reduce high-intensity service utilization, and manage health care costs more effectively. Future research should expand to broader populations to validate these findings and refine early referral strategies for OPCS.