Tuesday, September 16, 2014

Life is short...

About two years ago, we took a gander at the cost of end-of-life-care:

"$33,382 for one hospital stay. $43,711 for the next. And a final $14,022 for the last three days of life. This is the cost of dying in America"

One imagines that these figures haven't changed much, and certainly that they haven't gone down. Still, it's something many of us have faced or will face, whether for ourselves or (often) a loved one. When to "pull the plug" is rarely an easy decision, but a company called Vital Decisions may be on to something:

"Imagine you're at home. Maybe that's in Florida, Wisconsin, Rhode Island, wherever. You have cancer. You just had another round of chemo, and the phone rings ... This is no telemarketing call - it’s about the end of your life."

Vital Decisions employs 50 social workers who reach out to folks to offer counseling and other assistance, even offering to reach out to the patient's health care provider or other family members.

The service is paid for by the insurer.

It's an interesting article, and a fascinating story, but there are a few details that remain unclear to me:

First, although it mentions that the service is provided and paid for by insurance companies, it doesn't say how Vital Decisions gets looped in./ One imagines that a participating carrier has a set of criteria, and once an insured hits a certain point (discernible from their claims history), the file is forwarded to Vital Decisions. According to the article, this practice is permissible, but I'm a little wary of that. I also wonder how amenable the health care providers are to discussing case details with the service, regardless of the patient's approval.

One can see why an insurer would want to bring in a 3rd party: it would seem, well, a bit self-serving for the carrier itself to suggest less-than-heroic measure, however rational that may actually be. By subcontracting this out to another party, there's a sort of arms-length quality to the discussion.

And there's this:

"By Daitz’ own rough estimate, the company’s services have resulted in about $10,000 less in health care spending per patient, “$100 million to the health care system in 2014.”

That's a lot of health care dollars not being spent, which may well be a good thing. But I'm also wary of looking at one's life as a series of calculations. No question that many folks would suffer a great deal less if they moved from acute to palliative care, and Vital Decisions claims that this is at least partly because "critical conversations about end-of-life care just aren't happening enough and the company's goal is to foster them."

That in and of itself seems pretty admirable. On the other hand, I can't help but think that insurance companies are not hiring companies like Vital Designs in order to just spend more money: they have a real incentive to cut costs. And that's also not a bad thing: again, look at those numbers from 2012. Since health care costs drive health insurance costs, it's to everyone's benefit to look for meaningful, justifiable ways to rein in spending.

What say you? Is this a good way to encourage end-of-life-care decision-making, or simply another way for carriers to cut costs?

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