CAPC Payment Accelerator: Financial Sustainability for Community Palliative Care Programs
November 7, 2018 | 8:00 am - 5:00 pm
The Rosen Centre Hotel
Beyond Fee-For-Service: New Financing Strategies for Palliative Care
Palliative care programs have long struggled to secure financing adequate to support the work of the team. Billing fee-for-service for palliative care under Medicare and other payers does not come close to covering costs, resulting in teams too understaffed to meet the needs of their patient population, along with constant battles for organizational and philanthropic resources. But things are starting to change. Thanks to recent shifts away from fee-for-service payment for volume of patients seen, and toward value-based payment for quality outcomes, there are new paths for financial sustainability for palliative care. More teams are now entering into contracts with local health insurance plans and ACOs for per member per month fixed payments in return for palliative care services for the plan’s highest-risk, highest-need patients*.
Because of the well-known impact of palliative care on improving care and quality of life for the sickest and most vulnerable patients, health insurance plans want our services for their members. We, in turn, need the financing these plans can bring to compensate us for our work. How can palliative care and hospice teams learn how to do this?
CAPC’s unique Payment Accelerator is designed to help palliative care and hospice teams gain these skills. This deep-dive, one-day workshop kicks off 12 months of virtual access to resources and mentoring from experienced professionals, and includes practical content on what we need to bring to the table; group and team exercises; webinars; and case studies/perspectives from both payers and palliative care programs that have established sustainable financial partnerships.
Participants will learn all the basics of financial partnerships, including assessing the pros and cons of potential partners; understanding value-based payment contracts and payment models; advice on meeting contract obligations and using resources efficiently; and the “dos and don’ts” of negotiation and business relationships. This information will also be helpful for any organization interested in the proposed Medicare alterative payment model (APM) under consideration by the Center for Medicare and Medicaid Innovation (CMMI) at CMS.
What will you take away from the Accelerator workshop?
- In-depth understanding of how to identify, target, and engage financing partners for negotiation
- How to think realistically about your program design to ensure sustainability and care quality for patients with serious illness under fixed payment models or case rates
- Evaluating feasibility and quality of a range of types of payment models and contracts
Who should attend?
The Payment Accelerator is for palliative care programs delivering services beyond the hosiptal setting, in patients' homes, office practices, and long-term care. We recommend that teams of 2-3 attend the one-day workshop, including the following roles:
- Clinical program leadership
- Financial, contracting, or business development/marketing leadership (Ask your organization's clinical leadership to help you identify the best team member to bring. They may have titles that include Financial, Managed Care, Business Development, External Relations, and Population Health.)
*Lustbader, D, M Mudra, C Romano, et al. “The Impact of a Home-based Palliative Care Program in an Accountable Care Organization.” J Palliat Med, (2016): 20(1) and Cassel, JB, KM Kerr, DK McClish, et al. “Effect of a Home-based Palliative Care Program on Healthcare Use and Costs.” J Am Geriatr Soc, (2016): 64(11).
“[The Payment Accelerator] is the most comprehensive program any of us has experienced. It is not repetitive, it’s not full of fluff. Not only did it build our knowledge base, but it helped unite our team and helped us build connections with other agencies and programs."
- 2017 Accelerator attendee