Summary
How a leading ACO reduced total cost of care in the last year of life by combining a digital advance care planning platform with longitudinal clinical support.
Houston Methodist saves over $11,000 per patient with guided advance care planning
How a leading ACO reduced total cost of care in the last year of life by combining a digital advance care planning platform with longitudinal clinical support.
The bar is rising, and the next dollar of savings is harder to find
Performance Year 2024 was a strong year for the Medicare Shared Savings Program. It returned record net savings to Medicare and most ACOs earned shared savings. That result also sets the benchmark every ACO is measured against going forward, and mature ACOs face rebasing pressure in their next agreement period. The LEAD model, which replaces ACO REACH in January 2027, extends total cost of care accountability further.
The levers that drove early savings, including transitions of care, chronic disease management, and preventive screening, are now baseline performance across the cohort. The last year of life is the largest remaining cost wedge that few ACOs have systematically addressed, and it is where the gap between what patients want and what they receive is widest.
Why traditional ACP fails for ACOs
Without advance care planning, patients in their final years often receive care that does not reflect what they want. Three barriers keep it from happening.
ACOs managing thousands of attributed beneficiaries cannot staff enough social workers or chaplains to conduct ACP at population scale.
When ACP happens in the exam room, the visit becomes the first conversation, consuming PCP time and reducing billing efficiency.
Most ACOs lack a digital first ACP workflow. Paper forms get lost and completed documents never reach the EHR.
Identify, invite, and support, with no new FTEs
Koda stratifies your attributed population by risk, engages patients in the channel they prefer, and writes signed legal preferences back to the chart as discrete data. Most organizations struggle to make advance care planning happen. Koda does the heavy lifting.
Savings come from the quality of the conversation and the alignment it creates inside the family, not from the legal document itself. In the Houston Methodist cohort, members who engaged in the process saw savings whether or not their directive was ultimately signed. Registries answer where a document lives. They do not make the conversation happen.
Patients complete the experience on any device, plans integrate into EMR workflows so goals are never stranded in mailed packets or PDFs, and the model scales across populations with an 85% completion rate and an NPS of 87.
Houston Methodist proves what is possible
Houston Methodist Coordinated Care is one of Houston’s largest ACOs and the top academic medical center ACO in per patient cost savings, serving more than 50,000 Medicare beneficiaries. It faced low ACP engagement, high patient costs in the last year of life, and care misaligned with patient goals. One year after deploying Koda’s patient facing platform across the ACO, the results speak for themselves.
| Measure | Koda patients vs. matched controls |
|---|---|
| Total cost of care, last 12 months of life | $11,237 lower |
| Median savings per patient | $8,520 (42% decrease) |
| Terminal hospital admissions | 79% fewer |
| Inpatient length of stay | 24% shorter |
| ICU utilization | 33% lower |
| Hospice utilization | 51% higher, 25% longer stays |
| Patient Net Promoter Score | +83 |
$21,900
$10,663
Completion rates hold across every subgroup
ACP completion held steady across race, sex, and socioeconomic status. All Koda content is written at a sixth grade reading level.
145 Koda users, matched one to one against 145 controls
HMCC identified a population of seriously ill patients to refer to Koda for enrollment. Previously published results documented that 52.7% of these members completed their ACP, equitably across race, gender, and socioeconomic status. This retrospective analysis assessed the impact on utilization and cost for Koda users.
The analysis was completed by a third party analytics team. Each participant was matched using a high resolution digital twinning methodology accounting for demographics, clinical risk, predicted mortality, and social determinants of health. Risk adjusted outcomes were assessed over a 12 month follow up period using Medicare fee for service claims data.
“In many provider scenarios, the start of the ACP conversation is lost to follow up. A lot of ACP only gets followed up on when the patient is in critical condition. I was inspired by Koda as a platform. It’s patient centered and patients can do this in the comfort of their home with loved ones. It also embedded the necessary signatures, including having the document notarized.”
Julia Andrieni, MDSenior Vice President, Population Health and Primary Care. President and CEO, Houston Methodist Coordinated Care ACO
“Before Koda, it was very challenging to provide advance care planning. We didn’t have an alternative beyond mailing packets, which patients weren’t using. Koda has made ACP seamless. We refer our patients to them and they take it from there, reducing the burden on our nurses.”
Agnes Kats, RNManager of Outpatient Nursing Programs, Houston Methodist Coordinated Care
Client Feedback
"Koda has been so impactful to our value based care initiatives because it takes the burden of advance care planning off the provider and allows patients to do it in the comfort of their own home, at an accessible reading level, in a culturally sensitive way."
Julia Andrieni, MD Senior Vice President, Population Health and Primary Care. President and CEO, Houston Methodist Coordinated Care ACO
