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
MEMBERS ONLY locked

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
MEMBERS ONLY locked

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
MEMBERS ONLY locked

Presentation to Society of Actuaries on calculations for case rate payment.

Short-Term Home-Based Palliative Care Benefits
MEMBERS ONLY locked

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.

Sample Provider Education Document
MEMBERS ONLY locked

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.

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
Sample Home-Based Palliative Care Contract Amendment for Home Health Providers
MEMBERS ONLY locked

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.

Sample Home-Based Palliative Care Contract Amendment for Medical Practices
MEMBERS ONLY locked

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.

Sample Provider Education Document
MEMBERS ONLY locked

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.

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
MEMBERS ONLY locked

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
MEMBERS ONLY locked

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
MEMBERS ONLY locked

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
MEMBERS ONLY locked

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.

Sample Member Mailing
MEMBERS ONLY locked

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.

Guidance on Measurement and Evaluation
MEMBERS ONLY locked

Selecting metrics and processes to evaluate the impact of the palliative care strategies.