Overview of U.S. Health Care Payment and Policy
Course 1 of 6
Understand how Medicare, Medicaid, and private payers share responsibility for health care costs, and the financial impact on patients and families.
Allison Silvers, MBA
Allison Silvers has been with CAPC since 2016, working to integrate palliative care into population health and value-driven strategies. In this time, Ms. Silvers has educated payers and policymakers on both the value of palliative care and the key strategies that ensure access and quality, while also educating palliative care programs on opportunities under value-based payment.
Her accomplishments at CAPC include:
- Launching the CAPC Payment Accelerator to advance financial partnership skills among palliative care leaders
- Leading learning communities for Medicare Advantage plans, accountable care organizations, PACE programs (Program of All-Inclusive Care for the Elderly), and 'disrupter’ organizations
- Supporting actuarial analysis and regulatory guidance for Medicaid palliative care benefits
- Creating the Serious Illness Scorecard – a new, comprehensive way to evaluate state capability to meet the needs of families facing serious illness
- Leading CAPC’s efforts to promote caregiver support programs in hospitals and other health care organizations.
Prior to joining CAPC, Ms. Silvers served as the chief strategy office for VillageCare, where she oversaw innovations in chronic and long-term care services, as well as quality improvement efforts. She also helped launch two health insurance companies and has served as a long-term care subject matter expert for New York State. Ms. Silvers holds an MBA from Yale University, a BS in economics from the Wharton School, University of Pennsylvania, and a Geriatric Scholar Certificate from the City University of New York.
Selected Publications:
- Janoski BE, Kiel M, Silvers A, et al. Opportunities for Improving Access to Palliative Care for Dual Eligible Individuals with Serious Illness, ATI Advisory, June 2024
- Silvers A. Serious Illness Strategies: Driving Value in High Need Populations, January 2022
- Silvers A, Meier DE, Krebbs R, et al. Driving Improvements in Hospital Care through Palliative Care Quality Incentives. Better Care Playbook blog, June 11 2020
- Silvers A, Fields T, Kytonen A, and Meier DE, Medicare Advantage Flexibility: Getting Started on the Path to Improving Care for Seriously Ill Beneficiaries Health Affairs Forefront, July 6, 2018
From the Blog
Driving Improvements in Hospital Care through Palliative Care Quality Incentives
How two health plans are using quality incentives to expand hospital-based palliative care and improve access for patients living with serious illness.
Navigating Payment Models: What Palliative Care Teams Need to Know
A practical overview of health care payment models, covering key features, how to identify the model you're working under, and ways to optimize palliative care within each.
4 Ways You Can Take Action with CAPC’s New Serious Illness Scorecard
The landscape of care for people living with serious illness has changed. New Scorecard and state reports assess nationwide capabilities and support action among palliative care champions.
Courses
Medicare and Medicare Advantage: How they Work and the Impact on Care Delivery
Course 2 of 6
Examine what Medicare does and doesn't cover, while exploring the rise of Medicare Advantage and its impact on patients and providers.
Medicaid, Veterans Health, and Long-Term Services and Supports
Course 3 of 6
Learn how Medicaid and VA benefits support vulnerable patients and families needing palliative care, and who qualifies for these programs.
Fee-for-Service Payment and Quality Oversight
Course 4 of 6
Explore how fee-for-service payment works, its impact on quality, and strategies to optimize both revenue and performance under this model.
Value-Based Payment and Alternative Payment Models
Course 5 of 6
Learn how value-based payment models tie quality to cost, and explore strategies for balancing priorities when navigating both fee-for-service and value-based care.
The Role of Profit in U.S. Health Care
Course 6 of 6
Examine the rise of for-profit health care, why investors are drawn to the field, and the impact of profit incentives on care delivery.
Payment, billing, and fundraising tools for inpatient and community-based palliative care programs.
Includes 21 resources.
Training and clinical tools for oncology clinicians from all disciplines.
Includes 32 resources.
Resources for palliative care programs working with payers and other financial collaborators, including contracting resources.
Includes 15 resources.
Disruptor organizations can build skills and capabilities in palliative and geriatric care to achieve strong outcomes.
Includes 17 resources.
Explore recent federal palliative care initiatives, learn about opportunities for federal action, and access guidance on policy implementation.
Includes 25 resources.
Toolkit for building a business plan and budget, forming financial partnerships, and operating the program efficiently.
Includes 30 resources.
Tools to help health professionals improve health equity for all people living with serious illness.
Includes 52 resources.
Use this toolkit to evaluate models and design and operate a long-term care palliative care program.
Includes 33 resources.
Use this toolkit to select program measures that demonstrate value and support quality care delivery. Overcome common measurement obstacles and synthesize program data.
Includes 13 resources.
Toolkit for finding the right patients at the right time to address gaps in care.
Includes 31 resources.
Tools for business planning, developing a program budget, and billing for pediatric palliative care services.
Includes 14 resources.
A process and tools for stabilizing and strengthening palliative care programs during COVID-19.
Includes 6 resources.
Improving operations and training clinical staff to identify, stratify, and meet the needs of patients living with serious illness at the population level.
Includes 20 resources.
Use this toolkit to develop new programs and benefits for members with serious illness while driving improvements throughout the provider network.
Includes 40 resources.
Improving productivity and efficiency to ensure team health and operating within budget.
Includes 20 resources.
A curated collection of key articles covering palliative care needs, as well as specialty palliative care services and impact.
Includes 32 resources.
Resources for delivering high-quality palliative care in the context of significant resource constraints.
Includes 28 resources.
Tools for translating operational and service decisions into a realistic budget and business plan.
Includes 10 resources.
Use this toolkit to learn the issues and opportunities, explore recent state initiatives, and access guidance on implementation.
Includes 44 resources.
Tools for all aspects of palliative care telehealth delivery, from selecting the technology platform, to ensuring meaningful encounters, to billing appropriately.
Includes 23 resources.
Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
Includes 25 resources.
A coordinated effort to develop a national strategic plan to incentivize the delivery of high-quality care for people living with a serious illness.
Includes 11 resources.
Resources to help hospitals and other health care organizations design, launch, and grow sustainable caregiver support programs.
Includes 34 resources.
Tools to help payers, policymakers, and providers understand best practices for delivering quality care during a serious illness, and to identify certifications that demonstrate adherence to third-party quality standards.
Includes 33 resources.
These tools can be used to make the case for palliative care investment with organization leaders, health plans, colleagues, and community partners.
Includes 22 resources.