The Impact of a Home-Based Palliative Care Program in an Accountable Care Organization

Dana Lustbader
Mitchell Mudra
Carole Romano
Ed Lukoski
Andy Chang
James Mittelberger
Terry Scherr
David Cooper
Peer-Reviewed Article
September 2021


Home-based palliative care program implemented within an accountable care organization (ACO) created cost savings through reduced hospital admissions and increased hospice length of stay (LOS).


Many chronically or terminally ill patients, who could benefit from palliative care services, are excluded from the Medicare Hospice Benefit due to their desire to continue treatment or a lack of a certifiable hospice diagnosis. ProHEALTH Care, a New York-based multispecialty physician practice, implemented a home-based palliative care program for high-need patients within their Medicare Shared Savings Program Track 1 ACO. This analysis quantified the cost and resource utilization of ProHEALTH Care Support program participants versus patients in the control group who did not participate in the home-based palliative care program and instead received usual care.


Home-based palliative care participants experienced lower costs (in Medicare Parts A, B, and D spending) in the final year of life versus the control group. In the final three months of life, cost per patient was lower for both Medicare Parts A and B. There was no significant difference in Medicare Part D spending between those receiving ProHEALTH Care Support services and those that received usual care for this period. In the final month of life, individuals who received home-based palliative had 34 percent fewer hospital admissions and 20 percent fewer emergency room visits compared to those in the control group. Finally, both hospice enrollment and LOS were significantly longer for program participants compared to the control group.


Home based-palliative care programs allow patients to manage their symptoms, and in some cases die, within the home. Implementing a home-based palliative care program within an ACO can lead to cost savings due to decreased hospital utilization and increased enrollment and LOS in hospice programs.

Posted to The Playbook on