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

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.

Guidance on Benefit Design

Modifying existing benefits and adding new benefits.

Payment Arrangements Options
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Overview of the payment arrangements that currently exist for palliative care services.

Medicare 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.

Home-Based Palliative Care ROI Calculator
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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.

Building an Actuarial Model for Home-Based Palliative Care
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Presentation to Society of Actuaries on calculations for case rate payment.

Short-Term Home-Based Palliative Care Benefits
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Examples of benefits currently in use, focusing on interventions of less than three months.

Purchaser 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.

Eliminating Cost Sharing for Palliative Care and Advance Care Planning
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A summary of guidance from health plans on identifying palliative care services and ensuring those services are not subject to deductibles and co-pays.

Sample ACP Payment Policy
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A resource providing a sample provider-sponsored health plan's ACP payment policy.

Sample Palliatve Care Payment Policy
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This document provides a sample provider-sponsored health plan's palliative care payment policy.

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.

Guidance on Payment and Incentives

Implementing network competency incentive programs and paying for specialty palliative care.

Recommended 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.

Innovative Approaches to Caring for Complex Patient Populations: The Community Paramedicine Experience

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.

Proactive Identification for Health Plans and ACOs: A Guide
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Why proactive identification is important, how to build an algorithm, recommended first steps, and practical tips.

Case 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.

Screening and Assessment for Key Gaps in Care
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Screening questions and burden assessments for case management of people with serious illness.

Case 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.

Best Practices in Medical Management for Members with Serious Illness
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Good, better, and best practices for case management and utilization management.

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
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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.

Guidance on Measurement and Evaluation
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Selecting metrics and processes to evaluate the impact of the palliative care strategies.

Serious Illness Strategies for Health Plans and ACOs

Webinar presentation on a population health approach to care for patients with serious illness.