So what do we know about cost of care at the end of life? The short of the answer is cost of care at the end of life are enormous. We know that we spend approximately 25% of our annual Medicare expenditure in the last year of life with a lot of those costs being in the last few months of life. And all of that expenditure would be very reasonable and justifiable if it actually led to improved outcomes for patients. And the data unfortunately said just that it doesn’t. Now we have to ask the question then.

What are actually the drivers of high cost of care at the end of life? And they’re often avoidable issues like ER visits, hospitalizations, and ICU stays. We know that around two thirds of Medicare beneficiaries will spend at least one hospitalization in the last 90 days of life and you’re more likely than ever, now than even 20 years ago, to spend time in an ICU in the last month of life. And again, this would all be reasonable if it led to better outcomes.

But the challenge we see is that in the US 70 to 80% of patients when we ask them, would want to have their last days and weeks at home surrounded by loved ones.
The issue is that it’s actually the opposite is true is that 70 to 80% of people actually don’t die at home in the way they want to in the US. They’re in facilities, they’re in the hospital, and there’s a lot of room for improvement.

How can we make that improvement happen? Well, we believe that high quality supportive care is a significant way to address these issues, and the data suggests that it can be incredibly effective on multiple levels.

The first is by utilizing high quality symptom management. We can address drivers that ultimately end up putting patients in hospital like nausea, shortness of breath, pain, global failure to thrive issues as a sign of decline, that oftentimes manifests as symptom issues. And if we can get involved early and provide that supportive care, we can keep people out of the hospital from the point of engagement all the way through the end of life.

The second way that supportive care can be really beneficial is by helping patients cope with their illness and better understand what that illness means to them, particularly as it relates to prognosis. We know that when patients have a better sense of their prognosis, they’re going to make very different decisions, particularly at the end of life about how they want their care to look.

If I know that I have two months of life left, I’m probably gonna want to spend that time with family at home in a dignified peaceful setting than being in and out of the hospital and certainly in the ICU.

But the challenge is we don’t as a medical system do a very good job of ensuring that patients understand how much time they make. And these are hard conversations. But the data suggests even if it’s hard information patients actually want that information and actually need it to be able to make the best decisions possible for them and their loved ones. And when we can do it in a compassionate way, that then leads to again, both with symptom management and by guiding patients, through goals of care decisions can lead to much better outcomes.

Improve quality of life, more what we call goal concordant care, and meaning patients spend their end of life more in the way that they want to they’re more empowered and have more say over what that looks like. And that leads to much better outcomes for the patient, but also for their loved ones. And on top of that when we can do that it also leads to reduction in costs.

So we have this rare opportunity in medicine for patients with serious illness to be able to improve their quality of life for them and their loved ones through high quality supportive care and reduce unnecessary medical spend at the end of life.