Published in The American Journal of Managed Care

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

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.

Key Takeaways:

  • A predictive model was developed and validated as a tool for identifying patients in greatest need of end-of-life counseling.
  • In a randomized trial, model-directed end-of-life telephonic counseling was successfully delivered to 80% of Intervention group decedents.
  • Costs in the last six months of life were significantly lower for the Intervention group than the Control group.
  • Total savings attributed to the program were $5.95 million.