A Comprehensive Case Management Program To Improve Palliative Care

Objective: The objective of this study was to evaluate the impact of comprehensive case management (CM) and expanded insurance benefits on use of hospice and acute health care services among enrollees in a national health plan. Study Design: Retrospective cohort design with three intervention groups, each matched to a historical control group. Methods: Intervention groups were health plan enrollees who died after 2004: 3491 commercial enrollees with CM; 387 commercial enrollees with CM and expanded hospice benefits; and 447 Medicare enrollees with CM. Control groups consisted of enrollees who died in 2004 prior to the start of the palliative care CM program. The main outcomes measured were the proportion using hospice, mean number of hospice days, and number of inpatient days measured through medical claims. Results: Hospice use increased for all groups receiving CM compared to the respective control groups: from 30.8% to 71.7% (p<0.0001) for commercial members with CM and from 27.9% to 69.8% (p<0.0001) for Commercial members with CM and enhanced hospice benefits. Mean hospice days increased from 15.9 to 28.6 days (p<.0001) and from 21.4 to 36.7 days (p<0.0001) for these groups, respectively. Inpatient stays were lower for all groups receiving CM services compared to their respective control groups. Conclusions: Comprehensive health plan CM and more liberal hospice benefit design may help to break down barriers to hospice use; benefits might be liberalized within the context of such case management programs without adverse impact on total costs.