Effect of a Home-Based Palliative Care Program on Healthcare Use and Costs

J. Brian Cassel
Kathleen M. Kerr
Donna K. McClish
Nevena Skoro
Suzanne Johnson
Carol Wanke
Daniel Hoefer
Peer-Reviewed Article
November 2016


A home-based palliative care program using an interdisciplinary care team reduces hospital costs and unnecessary health care utilization for Medicare Advantage beneficiaries.


Patients with serious illness are at risk for using the hospital and emergency department to manage their symptoms, which drives up health care costs. The Transitions program at Sharp Healthcare in southern California provides home-based palliative care to complement traditional disease‐focused care for individuals with serious illness in their full risk Medicare Advantage arrangement. This study looks at data across seven years of the Transitions program and evaluates its impact on health care costs, readmission rates, intensive care unit (ICU) utilization, and death within 30 days of an admission. It evaluated patients being treated for four disease groups: cancer, chronic obstructive pulmonary disease (COPD), heart failure, and dementia.


Participants in the Transitions program had significantly lower hospital costs than the comparison group that received usual care. For three of the disease groups (cancer, COPD, and heart failure), there was no significant difference between cost of non-hospital care between groups, largely due to variability in the cost for patient’s non-hospital care. Additionally, in the last six months of life, health care costs remained steady for Transitions program participants compared to the control group, which had dramatically increased costs over that time span. Rates of readmission, ICU utilization, and death within 30 days of hospital admission were significantly lower for patients in the Transition program than patients in usual care.


Sharp Healthcare was able to create the Transitions program, a proactive home-based palliative care service, because of the flexibility offered in a full risk Medicare Advantage arrangement. Transitions' comprehensive care methodology reduced hospital and ICU utilization and as a result decreased overall cost of care. Health care organizations that treat patients with serious illness can implement a similar program to manage costs and resource utilization for these populations.

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