Financing a Palliative Care Program
Most programs combine several funding sources that can include billing revenue, investment by the home organization, partnership with health plans, and/or grants and philanthropy.
Use this toolkit to learn about financing strategies for inpatient and community-based programs, designing a business plan and budget, building financial partnerships, and operating efficiently so as to control costs while delivering high-quality care.
What’s in the Toolkit
Introduction to Payment
The basics of health care payment.
Monograph introducing U.S. health insurance with a focus on Medicare and what it means for palliative care.
Monograph introducing value-based payment and its implications for palliative care.
Defines key terms in payment vocabulary.
Ways to Pay for the Palliative Care Program
Financing methods for the palliative care program, including billing revenue, investment by the home organization, partnership with health plans, and/or grants and philanthropy. To learn how to make the case to financial stakeholders, see the related CAPC toolkits at the bottom of this page.
Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.
These tools can be used to make the case for palliative care investment with organization leaders, health plans, colleagues, and community partners.
A presentation clarifying how to present and request philanthropic funding for your palliative care program.
List of payment models that have been used for community-based palliative care services, along with their pros and cons for providers.
Navigating financing strategies for hospice-led palliative care, including Medicare fee-for-service, payment contracts, organizational support, and philanthropy.
Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.
Financial blueprint for supporting rural services. Stratis Health.
Estimating Volume and Capacity
A sustainable business plan depends upon making realistic assumptions about patient volume and staff capacity.
Estimate patient volume using national comparative data from the CAPC National Palliative Care Registry. Center to Advance Palliative Care, 2015.
Project staffing FTE per discipline based on expected patient volumes. Center to Advance Palliative Care, 2015.
Estimating Costs and Prices
Using service volume and staffing estimates to project program costs.
Free, interactive tool to help you estimate savings attributable to your hospital palliative care team.
Customizable workbook for community-based programs to create cost projections and key financial stats.
Qualitative explanation of budgeting and finding opportunities for cost-efficiency.
Business Planning and Budgeting
Translate service, staffing, cost, and billing revenue projections into a budget and business plan.
Building a budget and a business plan for the inpatient program. Includes business planning tools.
Training and a template for creating a business plan for your inpatient service.
Annotated budget worksheet that can be customized based on your program's patient, service, and staffing assumptions.
Building a budget and a business plan for the community-based program. Includes business planning tools.
Presentation on business planning fundamentals.
Maximizing Productivity and Operating Efficiently
Meet quality standards while optimizing efficiency in order to meet the assumptions you have laid out in your business plan.
Improving productivity and efficiency to ensure team health and operating within budget.
Contracting with Financial Partners
Guidance for contracting with health plans or other entities to secure funding your palliative care program.
Introduction to building partnerships that can financially support palliative care programs.
Monograph outlining the leadership and operational competencies that palliative care teams need to succeed under value-based payment.
How to find and select key consultants for financial relationships.
Harvard Business Review on developing and nurturing business relationships.
Lessons from CAPC Payment Accelerator alumni on building financial relationships with health plans.
Key contract clauses including term, termination, quality reporting parameters, and risk corridors.
Compliance issues and considerations for programs working with financial partners.
Contract strategies and protections for reducing downside risk, such as exclusion of outliers and stop-loss provisions.
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).
Diane E. Meier, MD, FACP, FAAHPM
Founder, Director Emerita and Strategic Medical Advisor, Center to Advance Palliative Care
Lynn Hill Spragens, MBA
Spragens & Gualtieri-Reed
Allison Silvers, MBA
Chief Health Care Transformation Officer
Torrie Fields, MPH
Founder and CEO
Jackie Selby, JD
Epstein Becker Green