Resources for Health Plans
Last Reviewed: March 4, 2019
Access to palliative care services results in improvement on quality measures, reduction in spending, and relief of suffering for members and their families. In addition to the general guidance and case studies available in CAPC’s Population Management and Palliative Care toolkit, health plans can use the resources below to develop new programs and benefits for members with serious illness while simultaneously driving improvements throughout their provider network.
What’s in the Toolkit
Specialty Palliative Care Services and Benefits
Guidance and tools to ensure access to specialty palliative care services for members living with serious illness.
CAPC Recommendations for Medicare Advantage Palliative Care Services
Specific services and approaches that Medicare Advantage plans should implement to ensure high-value care for enrollees with serious illness.
downloadGuidance on Benefit Design
Modifying existing benefits and adding new benefits.
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Payment Arrangements Options
Overview of the payment arrangements that currently exist for palliative care services.
members loginMedicare Advantage Flexibility: Improving Care for Seriously Ill Beneficiaries
Specific actions for plans looking to improve value-based design or expand supplemental benefits. Health Affairs, July 2018.
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Home-Based Palliative Care ROI Calculator
This second iteration of CAPC’s ROI Calculator provides a streamlined tool for modeling return on investment based on home-based palliative care program assumptions.
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Building an Actuarial Model for Home-Based Palliative Care
Presentation to Society of Actuaries on calculations for case rate payment.
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Short-Term Home-Based Palliative Care Benefits
Examples of benefits currently in use, focusing on interventions of less than three months.
members loginPurchaser Toolkit for High-Quality Serious Illness Care
Tools for employers and other stakeholders to specify required benefits and network competencies. Catalyst for Payment Reform and Center to Advance Palliative Care, 2018.
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Sample Provider Education Document
Developed by Blue Shield of California to ensure robust operations and quality within the palliative care provider network. Covers patient enrollment and disenrollment, billing and coding, and clinical care guidelines. Network management and legal can use this as a template to adapt to the needs of the organization.
members loginDesigning a Home-Based Palliative Care Program: A Guide for Payers
In-depth guide to building a health plan-based home palliative care program, based on the Blue Shield of California experience.
downloadProvider Network Strategies
Resources for identifying in-network or regional palliative care specialists, and for improving the communication and symptom management skills of all network providers.
Guidance on Provider Network Strategies
Improving network competencies and identifying palliative care specialists.
downloadGuidance on Payment and Incentives
Implementing network competency incentive programs and paying for specialty palliative care.
downloadRecommended Standards for Hospitals and SNFs
Structures and processes that all hospitals and skilled nursing facilities need to assure access to high-quality care for people with serious illness.
downloadInnovative Approaches to Caring for Complex Patient Populations: The Community Paramedicine Experience
Sample Home-Based Palliative Care Contract Amendment for Home Health Providers
Template contract language for partnering with existing network providers to provide home-based palliative care services. These tools are a starting point for network management and legal departments, and should be adapted to the needs of your organization. Based on documents in use at Blue Shield of California.
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Sample Home-Based Palliative Care Contract Amendment for Medical Practices
Template contract language for partnering with existing network providers to provide home-based palliative care services. These tools are a starting point for network management and legal departments, and should be adapted to the needs of your organization. Based on documents in use at Blue Shield of California.
members loginIdentification and Case Management Strategies
Tools and protocols for proactively identifying rising-risk members with serious illness, and improving case management interventions to ensure the right services at the right time for members living with serious illness.
Patient Identification and Assessment
Toolkit for finding the right patients at the right time to address gaps in care.
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Proactive Identification for Health Plans and ACOs: A Guide
Why proactive identification is important, how to build an algorithm, recommended first steps, and practical tips.
members loginCase Management for Health Plans and ACOs: Guidance for Engaging and Assessing Patients and Their Families
Best practices in case manager hiring and training, key processes and assessments, and practical guidance for getting started.
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Screening and Assessment for Key Gaps in Care
Screening questions and burden assessments for case management of people with serious illness.
members loginCase Managers: Addressing the Unique Needs of Patients with Serious Illness
This toolkit, Case Management for People with Serious Illness, provides online courses and resources for case managers to meet the needs of patients with serious illness.
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Best Practices in Medical Management for Members with Serious Illness
Good, better, and best practices for case management and utilization management.
members loginMember and Quality Assurance Strategies
While all parts of an organization must support new approaches to caring for the seriously ill, the resources in this section support the work of Quality Assurance and Member Services departments.
Health Plan Options Checklist
At-a-glance list of best practices for improving health plan operations in support of members with serious illness. Center to Advance Palliative Care, 2019.
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Sample Member Mailing
Sample mailing card from Blue Shield of California, for use as a template or to develop direct-to-patient information about palliative care and its benefits.
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Guidance on Measurement and Evaluation
Selecting metrics and processes to evaluate the impact of the palliative care strategies.
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