This toolkit equips palliative care programs with the knowledge and skills needed to operate successfully under value-based payment for community-based palliative care, including the CMMI Primary Care First Seriously Ill Population Option. These tools can help whether you are seeking a financial partner, figuring out how to price your program, adjusting your operations to achieve break-even under fixed payments, or contracting for palliative care services.

Watch the "How to Use CAPC Payment Accelerator Tools" for an introduction to key resources in this toolkit.

What’s in the Toolkit

Programs contracting for a fixed payment can use these tools to understand their program costs and identify ways of reducing expenses without reducing quality of care.

Payment Arrangement Options

List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.

Financial Analysis and Budgeting Tool for Community-Based Palliative Care
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Customizable workbook for community-based programs to create cost projections and key financial stats.

Understanding Costs and Prices: Companion Guide for Financial Analysis and Budgeting Tool
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Qualitative explanation of budgeting and finding opportunities for cost-efficiency.

Best practices for building and maintaining effective business relationships, including a template pitch deck that can be adapted for meetings with potential payment partners.

Payment Quick Tips: Payment Partnerships
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Introduction to building partnerships that can financially support palliative care programs.

Payment Quick Tips: Understanding Medicare, Medicaid, and Commercial Insurance
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Monograph introducing U.S. health insurance with a focus on Medicare and what it means for palliative care.

Payment Quick Tips: Value-Based Payment Capabilities
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Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment.

Payment Quick Tips: Value-Based Payment Introduction
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Monograph introducing value-based payment and its implications for palliative care.

Payment Arrangements Options

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

Opportunity Assessment Worksheet
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Define strengths and opportunities as you seek financial partners.

Home-Based Palliative Care ROI Calculator
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A streamlined calculator for modeling return on investment based on home-based palliative care program assumptions.

Partnership Introductory Meeting or Pitch Deck
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A template presentation to introduce your services, their benefits, and your "ask" for support. Use within your organization or when partnering with health plans or ACOs.

Advice from the Inaugural CAPC Payment Accelerator Class
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Lessons from CAPC Payment Accelerator alumni on building financial relationships with health plans.

Lessons Learned from Payer-Provider Partnerships for Community-Based Palliative Care

8 lessons from among California Medicaid plans and community-based providers. California Health Care Foundation, 2018.

Simple Rules for Making Alliances Work

Classic Harvard Business Review article on developing and nurturing business relationships.

Anticipating Stakeholder Reactions
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This document can help you respond to questions from senior leaders and decision-makers as you work to secure financial support for your palliative care program.

Tools to select appropriate quality measures for your program and to understand realistic targets for utilization and spending.

Quality Measures Used by Health Plan and Health System Partners to Evaluate Palliative Care Programs
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Quality measures valued by health plans and health systems.

CAPC Measurement Guide
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Recommendations for measures and approaches to evaluating palliative care services that enable growth and improvement.

Guidance on identifying, risk-stratifying, and engaging high-risk patients with serious illness.

Population Stratification Considerations
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Guidance on dosing interventions allocating visit frequency based on patient risk.

Communicating with Treating Clinicians about the Implications of Frailty
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Identifying patients with frailty who are at high risk for health care utilization and adverse outcomes.

Patient Identification and Engagement Guide
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Guidance on finding and enrolling patients, and working with treating providers. Updated, November 2019.

Staffing Models Inventory for Home-Based Palliative Care Programs
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Staffing models and benchmarks used by home-based programs.

CAPC strongly recommends that programs work with legal and financial professionals in developing payment contracts. Share these tools with your legal team to get a head start on safe contracting.

Template Memorandum of Understanding (MOU)
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The "Memorandum of Understanding" (MOU) is a brief document that outlines mutual responsibilities. Follow this outline to draft an MOU (must be reviewed by legal counsel).

Contract Protections for Downside Risk
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Contract strategies and protections for reducing downside risk, such as exclusion of outliers and stop-loss provisions.

Key Contract Provisions for Payment Contracts
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Key contract clauses including term, termination, quality reporting parameters, and risk corridors.

Regulatory and Licensure Considerations for Community-Based Palliative Care
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Compliance issues and considerations for programs working with financial partners.

Tips for Hiring Lawyers and Actuaries / Financial Advisors
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How to find and select key consultants for financial relationships.

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