The Medical Home Model and Palliative Care

"At Home Support", a program developed by Hospice of Michigan,  is an advanced illness coordinated care solution focused on providing services to the 5 percent of Medicare patients in an ACO or Medicare Advantage network who account for 50 percent of the cost.  These patients typically have Stage IV chronic illness with comorbidities and an expected median life span of 24 months. Developed through 12 years of evidence-based outcomes research, "At Home Support" improves quality outcomes and patient experiences,  while supporting  stressed family members. In addition, it is saving 30 percent net total health care costs for this 5 percent cohort. These savings are primarily produced from substantial decreases in unnecessary ER utilization, hospitalization and rehospitalization.