HIGHLIGHTS
- CMS wanted to evaluate a program that provides both palliative and hospice care.
- Abt conducted a mixed-method evaluation of facilities, beneficiaries, and caregivers.
- The program showed promise, offering improved quality of care and savings for CMS.
The Challenge
Typically, terminally ill Medicare beneficiaries must choose between enrolling in hospice or continuing to receive curative treatment. The Centers for Medicare & Medicaid Services’ (CMS) Medicare Care Choices Model (MCCM) gives beneficiaries the choice to receive supportive services from participating hospices while continuing to receive treatment for their terminal condition, including care coordination and case management, nursing and medical social services, hospice aide care, and bereavement counseling for enrollees and their caregivers. To assess MCCM’s efficacy, CMS contracted with Abt to conduct a mixed-methods evaluation.
The Approach
To evaluate MCCM, Abt analyzed characteristics and experiences of participating hospices, enrolled beneficiaries, and the subgroup of enrolled beneficiaries who died during the relevant study period, relative to a carefully constructed comparison group.
The Results
The results of the evaluation were promising. Among them, we determined:
- MCCM led to a 25 percent decrease in total Medicare expenditures, which generated $21.5 million in net savings between January 1, 2016 and September 30, 2019.
- MCCM reduced the number of potentially burdensome hospital encounters. The model reduced emergency department visits by 28 percent, observational stays by 21 percent, inpatient admissions by 36 percent, and intensive care unit admissions by 57 percent during the last 180 days of life. From a quality-of-care standpoint, avoiding hospital encounters reduces burdensome transitions across care settings and increases beneficiaries’ quality of life beyond what claims data alone would show.
- Hospice-documented treatments successfully alleviated symptoms for 90 percent or more of enrollees who were screened and showed symptoms.
At-A-Glance Report – Third Annual Report (PDF)
- Medicare Care Choices Model - Third Annual Report (PDF)
- Medicare Care Choices Model - Third Annual Report Technical Appendices (PDF)