Impact of home-based, patient-centered support for people with advanced illness in an open health system: A retrospective claims analysis of health expenditures, utilization, and quality of care at end of life

Background: Home-based care coordination and support programs for people with advanced illness work alongside usual care to promote personal care goals, which usually include a preference for home-based end-of-life care. More research is needed to confirm the efficacy of these programs, especially when disseminated on a large scale. Advanced Illness Management is one such program, implemented within a large open health system in northern California, USA. Aim: To evaluate the impact of Advanced Illness Management on end-of-life resource utilization, cost of care, and care quality, as indicators of program success in supporting patient care goals. Design: A retrospective-matched observational study analyzing medical claims in the final 3months of life. Setting/participants: Medicare fee-for-service 2010-2014 decedents in northern California, USA. Results: Final month total expenditures for Advanced Illness Management enrollees (N=1352) were reduced by US$4824 (US$3379, US$6268) and inpatient payments by US$6127 (US$4874, US$7682). Enrollees also experienced 150 fewer hospitalizations/1000 (101, 198) and 1361 fewer hospital days/1000 (998, 1725). The percentage of hospice enrollees increased by 17.9 percentage points (14.7, 21.0), hospital deaths decreased by 8.2 percentage points (5.5, 10.8), and intensive care unit deaths decreased by 7.1 percentage points (5.2, 8.9). End-of-life chemotherapy use and non-inpatient expenditures in months 2 and 3 prior to death did not differ significantly from the control group. Conclusion: Advanced Illness Management has a positive impact on inpatient utilization, cost of care, hospice enrollment, and site of death. This suggests that home-based support programs for people with advanced illness can be successful on a large scale in supporting personal end-of-life care choices.