Cost Analysis and Policy Implications of a Pediatric Palliative Care Program

Abstract

CONTEXT: In 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child’s life expectancy. OBJECTIVES: We assessed the change from prior to PFC enrollment to the enrolled period in: (1) health care costs per enrollee per month (PEPM); (2) costs by service type and diagnosis category; and, (3) health care utilization (days of inpatient care and length of hospital stay). METHODS: A pre-post analysis compared enrollees’ health care costs and utilization up to 24 months prior to enrollment with their costs during participation in the pilot, from January 2010 through December 2012. Analyses were conducted using paid Medicaid claims and program enrollment data. RESULTS: The average PEPM health care costs of program enrollees decreased by $3,331 from prior to their participation in PFC to the enrolled period, driven by a reduction in inpatient costs of $4,897 PEPM. PFC enrollees experienced a nearly 50% reduction in the average number of inpatient days per month, from 4.2 to 2.3. Average length of stay per hospitalization dropped from an average of 16.7 days prior to enrollment to 6.5 days while in the program. CONCLUSION: Through the provision of home-based therapeutic services, 24/7 access to medical advice, and enhanced, personally tailored care coordination, PFC demonstrated an effective way to reduce costs for children with life-limiting conditions by moving from costly inpatient care to more coordinated and less expensive outpatient care. PFC’s home-based care strategy is a cost-effective model for pediatric palliative care elsewhere.