Original ArticlesA Value-Based Payment Model for Palliative Care An Analysis of Savings and Return on InvestmentBernstein, Richard H. MD; Singh, Laura A. MPHAuthor Information Departments of Geriatrics and Palliative Medicine (Dr Bernstein) and Public Health (Ms Singh), Icahn School of Medicine at Mount Sinai, New York. Correspondence: Richard H. Bernstein, MD, 59 Maiden Lane, Floor 21, New York, NY (firstname.lastname@example.org). The authors wish to express their gratitude to Karol K. DiBello, who provided feedback on the manuscript.The authors are also grateful to Diane Meier, who offered suggestions on revising the paper; to Eric Price, who provided details on reinsurance; and to Arlen Collin, who helped prepare the risk adjustment data.The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. Journal of Ambulatory Care Management: January/March 2019 - Volume 42 - Issue 1 - p 66-73 doi: 10.1097/JAC.0000000000000259 Buy Metrics Abstract Five percent of the US population accounts for 50% of total health expenditures. This “5%” problem requires moderating Medicare cost trends. SPARK, a community-based palliative care program, focused on its costliest Medicare Advantage patients. This cohort's projected costs were 280% higher than average beneficiaries, based on Medicare's risk model. Despite significant losses during enrollees' first year, a positive 5.1% ROI was found over the program's 4 years when stop-loss insurance payments were included. SPARK demonstrates that a high-quality, community-based palliative care program can be financially self-sustaining using a value-based payment model with premium plus stop-loss income exceeding actual costs. © 2019 Wolters Kluwer Health, Inc. All rights reserved.