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

Use these tools for early, proactive identification and assessment to uncover potential areas of distress.

Proactive Identification for Health Plans and ACOs: A Guide

Best practices in selecting diagnoses and indicators of need.

Sample Diagnoses Codes to Identify Patients Living with Serious Illness

Population health entities can use this list to proactively identify people with potentially unmet palliative care needs.

Screening and Assessment for Key Gaps in Care

Screening questions and burden assessments for case management of people with serious illness.

Guidance and tools to ensure access to specialty palliative care services for members living with serious illness.

Serious Illness Strategies for Health Plans and ACOs

The case for health plans and accountable care organizations to advance access to quality palliative care, and practical guidance for implementation. Center to Advance Palliative Care, 2017.

Home-based Palliative Care Program Credentialing Recommendations

Recommended capabilities and competencies for payers and policymakers to contract with quality programs.

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.

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.

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

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

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

Sample Palliatve Care Payment Policy

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.

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.

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.

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