Vital Decisions Economic Impact Methodology Validated by Milliman Inc.

Milliman Analysis Reinforces Results of Recent Journal of Palliative Medicine Publication

Vital Decisions, a specialist in facilitating more effective Personal Advanced Illness Decision Making for patients and their families, saw their results from a recent Journal of Palliative Medicine (JOPM) study further strengthened today by a report completed by Milliman Inc., a premier global consulting and actuarial firm.

Milliman conducted a review of the research published in the June 2016 JOPM report “The Economic Impact of an Advanced Illness Consultation Program within a Medicare Advantage Plan Population,” which found that Vital Decisions’ Living Well Program resulted in an average savings of approximately $14,000 during an individual’s last six months of life. Milliman’s approach included an initial high-level review, a more detailed review of the data and assumptions used in the study, and an independent analysis of Vital Decisions’ methodology.

According to the Milliman Report:

“Overall, we find Vital’s methodology used to calculate the difference in net costs (total health care costs net of premiums) between members enrolled and not enrolled in Vital’s LWCP to be sound. The methodology of using matched pair analysis is commonly used in outcomes studies and is appropriate for a study where control and intervention populations are compared.      

Furthermore, we independently applied the methodology used in Vital’s report as a means to assess its reasonability.

Using Medicare Advantage eligibility and claims data for terminal patients provided by Vital, we independently calculated estimates of the mean cost difference. We observed members participating in the LWCP have, on average, 23% – 26% lower end-of-life care costs than members not participating. The differences observed did not consider Vital’s program fees.

Our review of Vital’s report and methodology found notable strengths. Specifically, the matched pair methodology reasonably addresses the potential selection bias and other differences between the control and intervention groups. While the sample size is relatively small compared to that needed to attain full credibility for a Medicare Advantage population, the results had strong statistical significance. Furthermore, we tested the sensitivity of the cost difference to alternative matching criteria and found the cost difference to be relatively insensitive. We also provided Vital with recommendations around future study enhancements and improvements.”

“We are pleased to have our program’s economic impact methodology and our results validated by a respected group like Milliman,” said Vital Decisions’ CEO Mitchell Daitz, “as it provides confirmation that after nearly a decade of working towards a more humanistic approach to Advance Illness Planning, and some 30,000 patient engagements each year to refine our processes, our methods for evaluating the financial effectiveness of our program are rock-solid and being affirmed by one of the most respected actuarial experts in the world.”

The specific Vital Decisions’ program analyzed was conducted over multiple sessions by advanced degree Specialists who telephonically interacted with the patient, and in many cases family members, identifying obstacles such as fear, denial, lack of self-confidence, and family dynamics – that may be inhibiting an individual’s ability to communicate preferences and values to their family and/or physicians. The intervention was designed to develop the intrinsic motivation to overcome these barriers, and enable the communication of an individual’s values and preferences so they may serve as the basis for current and future care decision-making.

For a copy of the complete Milliman Evaluation Summary email info@vitaldecisions.net.  Read the full Journal of Palliative Medicine study.