Value-Based Payment: Building a Financially Sustainable Palliative Care Service

Last Reviewed: March 4, 2019

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.

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Cost of Services Tool (COST) Workbook Blank

Last Updated: February 3, 2019

Customizable workbook for community-based programs to create cost projections. Excerpted from the CAPC Payment Accelerator, 2017.

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Cost of Services Tool (COST) User Guide

Last Updated: February 3, 2019

Using the COST worksheets to model community program costs based on service assumptions. Excerpted from the CAPC Payment Accelerator, 2017.

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COST Workbook Example

Last Updated: February 3, 2019

Sample workbook for modeling detailed service assumptions to generate program cost estimates. Excerpted from the CAPC Payment Accelerator, 2017.

Deep Dive into Understanding Costs

Last Updated: February 25, 2019

Webinar on projecting expenses for the community palliative care service.

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Staffing Models Inventory for Home-Based Palliative Care Programs

Last Updated: February 3, 2019

Staffing models used by home-based programs. Center to Advance Palliative Care, 2018.

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Population Stratification Considerations

Last Updated: February 3, 2019

Guidance on dosing interventions based on patient risk.

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Telehealth Start-Up Guide

Last Updated: February 3, 2019

Key components of telehealth service delivery, especially in a home-based palliative care program.

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

CAPC Payment Primer- What to Know about Payment for Palliative Care Delivery

Last Updated: March 5, 2019

This monograph covers the basics of Medicare, Medicaid, health plans and the alternative payment models that are taking hold in the U.S. The intent is to provide a solid introduction to health plans, payment concepts and key considerations as a foundation to support sustainable relationships with payers and other risk-bearing entities. Center to Advance Palliative Care, 2017.

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Payment Arrangements Options

Last Updated: February 3, 2019

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

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Potential Payer Partnerships

Last Updated: February 3, 2019

Overview of the range of potential financial partners for community palliative care.

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Opportunity Assessment Worksheet

Last Updated: February 3, 2019

Define strengths and opportunities as you seek financial partners.

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Pricing Development Guide For Palliative Care Providers Seeking Payment Contracts

Last Updated: February 3, 2019

Define program prices and determine the acceptability of prices offered by payers. Excerpted from the CAPC Payment Accelerator, reviewed 2018.

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Home-Based Palliative Care: Pricing

Last Updated: February 3, 2019

Estimating patient volume by referral type, time per encounter, and staff capacity. Center to Advance Palliative Care, 2018.

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ROI Calculator for a Home-Based Palliative Care Program

Last Updated: February 3, 2019

Calculates return on investment, based on the home-based palliative care program assumptions. CAPC Payment Accelerator, reviewed 2018.

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Partnership Introductory Meeting or Pitch Deck

Last Updated: February 3, 2019

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.

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Advice from 2017 Accelerator Alumni

Last Updated: February 3, 2019

Lessons from Accelerator alumni on building financial relationships with health plans.

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

Last Updated: February 3, 2019

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

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Simple Rules for Making Alliances Work

Last Updated: February 3, 2019

Harvard Business Review on developing and nurturing business relationships.

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Cost of Services Tool (COST) Workbook Blank

Last Updated: February 3, 2019

Customizable workbook for community-based programs to create cost projections. Excerpted from the CAPC Payment Accelerator, 2017.

MEMBERS ONLY unlock

Cost of Services Tool (COST) User Guide

Last Updated: February 3, 2019

Using the COST worksheets to model community program costs based on service assumptions. Excerpted from the CAPC Payment Accelerator, 2017.

MEMBERS ONLY unlock

COST Workbook Example

Last Updated: February 3, 2019

Sample workbook for modeling detailed service assumptions to generate program cost estimates. Excerpted from the CAPC Payment Accelerator, 2017.

Deep Dive into Understanding Costs

Last Updated: February 25, 2019

Webinar on projecting expenses for the community palliative care service.

watch

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

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Quality Measures Used by Health Plan and Health System Partners to Evaluate Palliative Care Programs

Last Updated: February 3, 2019

Quality measures valued by health plans and health systems.

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Recommended Program Measures and CAPC Measurement Toolkit

Last Updated: February 3, 2019

Recommended measures for inpatient and community palliative care programs, and using data to demonstrate value and perform continuous quality improvement.

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Utilization and Spending Benchmarks for Medicare Populations

Last Updated: February 3, 2019

Per capita utilization and spending for specific populations in Medicare. CAPC Payment Accelerator, 2017.

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

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Population Stratification Considerations

Last Updated: February 3, 2019

Dosing interventions based on patient risk level.

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Communicating with Treating Clinicians about the Implications of Frailty

Last Updated: February 3, 2019

Identifying patients with frailty who are at high risk for health care utilization and adverse outcomes.

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Health IT Functionality and Reporting Checklist

Last Updated: February 3, 2019

List of HIT capabilities needed by palliative care programs for population management and data monitoring.

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Patient Identification and Engagement Guide

Last Updated: April 8, 2019

Guidance on finding and enrolling patients, and working with treating providers.

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.

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Contracting Workflow for Providers

Last Updated: February 3, 2019

Capabilities, processes, and functions (such as marketing or finance) that must be demonstrated to secure payment.

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Template MOU

Last Updated: February 3, 2019

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).

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Contract Protections for Downside Risk

Last Updated: February 3, 2019

Understanding contract protections for downside risk, such as exclusion of outliers and stop-loss provisions.

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Key Contract Provisions for Payment Contracts

Last Updated: February 3, 2019

Key contract clauses including term, termination, quality reporting parameters, and risk corridors.

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Regulatory and Licensure Considerations

Last Updated: February 3, 2019

Legal obstacles impeding access to palliative care.

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Tips for Hiring Lawyers and Actuaries-Financial Advisors

Last Updated: February 3, 2019

Key roles when developing financial partnerships, including how to find and select these consultants.

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Related Toolkits See all 27 toolkits

Designing a Home-Based Palliative Care Program

Includes 100 resources:
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  • Business Planning and Program Financing
  • For Hospice-Led Programs
  • Measurement Tools
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  • Sample Policies and Procedures
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Demonstrating Value to Stakeholders

Tools to make the case for palliative care resources and financial partnerships, including: the palliative care evidence base, and downloadable tools for presenting the case.

Includes 28 resources:
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  • For Patients and Families
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Funding a Palliative Care Program

Toolkit for building a business plan and budget, forming financial partnerships, and operating the program efficiently.

Includes 44 resources:
  • Introduction to Payment
  • Ways to Pay for the Palliative Care Program
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  • Estimating Costs and Prices
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  • Contracting with Financial Partners
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