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.
Customizable workbook for community-based programs to create an operating budget and key financial stats. Each sheet can also be used individually. Center to Advance Palliative Care, 2021.
Qualitative explanation of how to use the Financial Analysis and Budgeting Tool, with suggestions for improving 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. Center to Advance Palliative Care, 2019.
US health insurance and what it means for palliative care. Center to Advance Palliative Care, 2019.
Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment. Center to Advance Palliative Care, 2019.
Introduction to value-based payment and its implications for palliative care. Center to Advance Palliative Care, 2019.
Overview of the payment arrangements that currently exist for palliative care services.
Define strengths and opportunities as you seek financial partners. Updated, November 2019.
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.
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. CAPC Payment Accelerator, 2018.
Lessons from 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.
Harvard Business Review on developing and nurturing business relationships.
Suggestions for how to respond to some common reactions by leaders and other stakeholders.
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.
Recommended measures for inpatient and community palliative care programs, and using data to demonstrate value and perform continuous quality improvement.
Guidance on identifying, risk-stratifying, and engaging high-risk patients with serious illness.
Guidance on dosing interventions based on patient risk.
Identifying patients with frailty who are at high risk for health care utilization and adverse outcomes.
List of HIT capabilities needed by palliative care programs for population management and data monitoring.
Guidance on finding and enrolling patients, and working with treating providers. Updated, November 2019.
Staffing models 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" or MOU is a brief document that outlines mutual responsibilities. Follow this outline to draft an MOU (must be reviewed by legal counsel).
Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.
Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
Legal obstacles impeding access to palliative care.
Key roles when developing financial partnerships, including how to find and select these consultants.
Diane E. Meier, MD, FACP, FAAHPM
Director Emerita and Strategic Medical Advisor, Center to Advance Palliative Care
Allison Silvers, MBA
Vice President, Payment and Policy
Torrie Fields, MPH
Founder and CEO
Tom Gualtieri-Reed, MBA
Spragens & Gualtieri-Reed
Dana Lustbader, MD, FAAHPM
Chief, Department of Palliative Care,
ProHEALTH an OPTUM Company
Lynn Hill Spragens, MBA
Spragens & Gualtieri-Reed