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.

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.

Pilot to Benefit: Considerations in Adding Home-based Palliative Care Benefits

A summary of pros and cons to home-based palliative care formal benefits, and a suggested pathway to start with a pilot

Resources for identifying in-network or regional palliative care specialists, and for improving the communication and symptom management skills of all network providers.

Hospital Palliative Care Incentive Programs

A blog describing two straight-forward and effective programs, one at Anthem Inc and one Highmark Blue Cross Blue Shield, incentivizing access to palliative care in network hospitals.

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

Measures that can be used by payers and policymakers to ensure quality care for people living with serious illness.

Tips for Network Provider Engagement in Training

How to engage clinicians in communication and symptom management skills training initiatives using CAPC's online courses.

Performance Guarantees for Network Training
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Example of performance guarantees that can be used to ensure impact of network training 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.

Proactive Identification for Health Plans and ACOs: A Guide
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Best practices in selecting diagnoses and indicators of need.

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.

Care Managers: Addressing the Unique Needs of Patients with Serious Illness

This toolkit provides online courses and resources for care 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.

Sample Script and Guidance: Cold-Calling Patients to Initiate Advance Care Planning
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This script for care managers provides guidance and sample language to use when calling without a prior relationship to begin advance care planning for patients with serious illness.