Most people have two relatively medically expensive times of their lives – when they are very young and when they are old.

The first year of children’s lives can be medically expensive for their parents. But if you look at study after study, most of the medical expenses over the course of a lifetime are when people are 65 or older.

The Centers for Medicare & Medicaid Services says the ratio in 2020 for health care spending for adults over 85 was 8.5 times what it was for children. It was actually the same ratio of spending for the same cohorts in 2010, as well.

So if you want to help control costs, one place to look is health care expenses as people get older.

A committee in Oregon is looking at possibly transforming the way the state compensates for a type of health care called palliative care and moving it to value-based care.

Although palliative care is often associated with end-of-life care, that is not required. Palliative care is usually defined as patient and family focused. It’s about optimizing quality of life and reducing suffering, whether or not a person can be cured. It’s not necessarily doing everything medically possible in treatment. It’s about providing options for patients and their families that may bring them more satisfaction, instead of just more expense.

The payment model in much of health care was traditionally fee for service. Go in and get your treatment and you pay for that treatment. It’s relatively simple. That model doesn’t necessarily pay attention to outcomes or quality of care.

Much medical care has moved to value-based care, driven by changes in federal health care compensation. Essentially providers get payments in a bundle generally tied to outcomes and cost targets. For instance, in some models providers get a total payment per patient for a certain time period, irrespective of the services delivered.

It can work. It can be tricky to get right.

The Oregon Health Plan has a plan to make at least 70% of payments to the state’s coordinated care organizations value-based by 2024. CCOs in Oregon make up the health care network for the Oregon Health Plan.

The committee looking into the switch in reimbursement for palliative care in Oregon already recognizes that there are challenges. Even providing palliative care is a challenge for rural communities, who may not have the number of providers necessary to use a team-based approach. Money is going to be an issue, too.

But might there be creative ways to do it?

Health care reformers are understandably intrigued by the potential of marrying value-based care and palliative care. It’s not clear if or how it could work in Oregon.

A state advisory council on palliative care is scheduled to meet on Dec. 14. More about that meeting here: tinyurl.com/PalliativeOR.