Health Plan Incentive Program to Improve Access to and Treatment of Palliative Appropriate Patients.

BACKGROUND: Health plans utilize various strategies, including benefits, network design, incentive programs, payment reform, and medical policy, to enhance the quality of medical care for their members. OBJECTIVES: Determine the benefits of palliative care, particularly within the context of an incentive-driven program for a sicker Medicare Advantage (MA) population. DESIGN: Retrospective cohort analysis to assess differences in outcomes between those receiving palliative care and a matched comparison. The sample consisted of Highmark MA members. The treatment group included members who had a palliative consultation during an inpatient admission, while the control group comprised members who had an eligible admission but did not receive a consultation. Patients were propensity score matched. SETTING/SUBJECTS: A total of 2095 matched Highmark MA members receiving care in the eastern United States between January 2020 and December 2023. MEASUREMENTS: Claims-derived total cost of care was assessed using a difference-in-differences analysis. Process measures included the number of referrals to a community-based palliative care program. RESULTS: The treatment group consistently had reduced costs relative to the matched controls (difference ranging from $4,485 to $4,827). Furthermore, referrals to community-based palliative care dramatically increased, with a 650% rise in 2022 and a 147% increase in 2023 compared to 2021. CONCLUSIONS: These findings suggest that incentive-based programs, particularly when targeting sicker populations through redesigned eligibility, can effectively align financial incentives with improved palliative care delivery. This contributes to both significant cost-efficiency and enhanced patient care coordination, as evidenced by reduced costs and a substantial increase in palliative care referrals.