• Joshua R Lakin, Brandon J Neal, Francine L Maloney, Joanna Paladino, Christine Vogeli, Joey Tumblin, Maryann Vienneau, Erik Fromme, Rebecca Cunningham, Susan D Block, and Rachelle E Bernacki.
• Ariadne Labs, Brigham and Women's Hospital & Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA. Electronic address: jlakin@ariadnelabs.org.
• Healthc (Amst). 2020 Jun 1; 8 (2): 100431.

BackgroundAt a population level, conversations between clinicians and seriously ill patients exploring patients' goals and values can drive high-value healthcare, improving patient outcomes and reducing spending.MethodsWe examined the impact of a quality improvement intervention to drive better communication on total medical expenses in a high-risk care management program. We present our analysis of secondary expense outcomes from a prospective implementation trial of the Serious Illness Care Program, which includes clinician training, coaching, tools, and system interventions. We included patients who died between January 2014 and September 2016 who were selected for serious illness conversations, using the "Surprise Question," as part of implementation of the program in fourteen primary care clinics.ResultsWe evaluated 124 patients and observed no differences in total medical expenses between intervention and comparison clinic patients. When comparing patients in intervention clinics who did and did not have conversations, we observed lower average monthly expenses over the last 6 ($6297 vs. $8,876, p = 0.0363) and 3 months ($7263 vs. $11,406, p = 0.0237) of life for patients who had conversations.ConclusionsPossible savings observed in this study are similar in magnitude to previous studies in advance care planning and specialty palliative care but occur earlier in the disease course and in the context of documented conversations and a comprehensive, interprofessional case management program.ImplicationsPrograms designed to drive more, earlier, and better serious illness communication hold the potential to reduce costs.Level Of EvidenceProspectively designed trial, non-randomized sample, analysis of secondary outcomes.Copyright © 2020 Elsevier Inc. All rights reserved.

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