By OPEN MINDS Circle
In a six-month pilot at a Mass General Brigham (MGB) hospital, an artificial intelligence (AI) decision support tool called Smart Hospice developed by Radial helped identify 24% more hospitalized Medicare beneficiaries (total of 17 people) with repeat skilled nursing facility stays who were likely to benefit from entering hospice. These 17 beneficiaries would not otherwise have been referred for a palliative care/hospice consultation without the AI tool. Of the 17 additional referrals, as of January 2024, four were currently enrolled in hospice, seven were actively considering hospice, two had not yet discussed hospice, and four died without hospice. Data collection is still ongoing, as transitions to hospice care typically occur months or even years after initial palliative involvement. Assuming timely hospice enrollment of the remaining non-expired beneficiaries, MGB reports that the Smart Hospice pilot will result in Medicare savings of $850,000 over five months, equivalent to approximately $2 million annualized.
The goal of the AI tool was to increase hospice/palliative care referrals for MGB’s Medicare Shared Savings Program (MSSP) accountable care organization (ACO) members to facilitate home-first care, improve inpatient and skilled nursing facility (SNF) capacity, and improve end-of-life care. Smart Hospice is a real-time decision support solution that does not require additional data entry. It draws data from claims, electronic health records, and health information exchanges to analyze comprehensive health care utilization. The goal is to identify “non-obvious” beneficiaries at risk of unnecessary medical interventions who might benefit from palliative care.
The MGB MSSP ACO internal data found that over 10% of members died within 30 days after discharge from a SNF. For ACO members with three or more SNF stays, the 90-day mortality rate was 30%.
The pilot took place at the 273-bed MGB Newton-Wellesley Hospital during 2023. In a presentation about the outcomes, the researchers said that over the course of the pilot, 9% of 1,522 hospitalized ACO members were recommended for a consult by the tool, with 40 receiving inpatient palliative consultation referrals.
Of the 1,522 total MSSP ACO members hospitalized at MGB Newton Wellesley Hospital during the pilot, the Smart Hospice tool recommended 135 for a palliative consultation. Of the 135 beneficiaries recommended for a consult 40 inpatient consultations were scheduled, 18 were recommended for referral to outpatient palliative care, 25 were already engaged in outpatient palliative or hospice services, 11 were discharged to hospice or died in the hospital, 18 recommendations were deferred by the consumer or family, and 23 had a different resolution. Of the 40 inpatient consultations referred, 23 referrals would have happened without Smart Hospice and 17 referrals would have been missed without Smart Hospice.
The pilot outcomes were presented in a case study presented by Amy Baughman M.D., medical director care continuum at Mass General Brigham; Kaitlyn Schweikert, population health program manager at Newton-Wellesley Hospital; and Anant Vasudevan M.D. MBA, chief medical officer at Radial. The researchers analyzed quantitative outcomes from the pilot and surveyed key stakeholders.
For more information, contact: Radial Analytics, 50 Beharrell Street, Suite A, Concord, Massachusetts 01742; 617-855-8214; Email: info@radialanalytics.com; Website: https://www.radialanalytics.com/