Value-Based Payment: Building a Financially Sustainable Palliative Care Service
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
Understanding Costs and Prices
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.
List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.
Customizable workbook for community-based programs to create cost projections and key financial stats.
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.
Introduction to building partnerships that can financially support palliative care programs.
Monograph introducing U.S. health insurance with a focus on Medicare and what it means for palliative care.
Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment.
Monograph introducing value-based payment and its implications for palliative care.
Overview of the payment arrangements that currently exist for palliative care services.
Define strengths and opportunities as you seek financial partners.
A streamlined calculator for modeling return on investment based on home-based palliative care program assumptions.
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.
Lessons from CAPC Payment Accelerator alumni on building financial relationships with health plans.
8 lessons from among California Medicaid plans and community-based providers. California Health Care Foundation, 2018.
Classic Harvard Business Review article on developing and nurturing business relationships.
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 valued by health plans and health systems.
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.
Guidance on dosing interventions allocating visit frequency based on patient risk.
Identifying patients with frailty who are at high risk for health care utilization and adverse outcomes.
Guidance on finding and enrolling patients, and working with treating providers. Updated, November 2019.
Staffing models and benchmarks used by home-based programs.
Contracting and Legal Issues
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.
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 strategies and protections for reducing downside risk, such as exclusion of outliers and stop-loss provisions.
Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
Compliance issues and considerations for programs working with financial partners.
How to find and select key consultants for financial relationships.
Diane E. Meier, MD, FACP, FAAHPM
Founder, Director Emerita and Strategic Medical Advisor, Center to Advance Palliative Care
Allison Silvers, MBA
Chief Health Care Transformation Officer
Torrie Fields, MPH
Founder and CEO
Tom Gualtieri-Reed, MBA
Spragens & Gualtieri-Reed
Dana Lustbader, MD, FAAHPM
Regional Medical Officer, Landmark Health, OPTUM
Professor of Critical Care & Palliative Medicin…
Lynn Hill Spragens, MBA
Spragens & Gualtieri-Reed