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

The basics of health care payment.

Payment Quick Tips: Understanding Medicare, Medicaid, and Commercial Insurance
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US health insurance and what it means for palliative care. Center to Advance Palliative Care, 2019.

Payment Quick Tips: Value-Based Payment Introduction
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Introduction to value-based payment and its implications for palliative care. Center to Advance Palliative Care, 2019.

Payment Glossary

Defines key terms in payment vocabulary. Center to Advance Palliative Care, 2017.

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.

Optimizing Billing Practices

Toolkit with billing and coding best practices for palliative care services delivered in the hospital or the community.

Tools for Making the Case

Guidance on making the case to organization leaders to secure budget for program startup and program operations.

Philanthropy Strategies: Creating a Palliative Care Advisory Board
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Recruitment, sample advisory board roles and responsibilities, and fundraising planning. Icahn School of Medicine at Mount Sinai, 2018.

Philanthropy Strategies
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A presentation on how to request philanthropic funding. Center to Advance Palliative Care, 2018.

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

Quick Tips: Financing Your Community- Based Palliative Care Program
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Navigating financing strategies for hospice-led palliative care including Medicare fee-for-service, payment contracts, organizational support and philanthropy. Center to Advance Palliative Care, 2019.

Alternative Payment for Palliative Care: Getting from Here to There Webinar Recording
Potential Payer Partnerships
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Overview of the range of potential financial partners for community palliative care.

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

Tools to develop financial partnerships including: making the case, contracting considerations, and how to use legal and financial advisers.

Sustainability Strategies for Community-Based Palliative Care

Financial blueprint for supporting rural services. Stratis Health.

A sustainable business plan depends upon making realistic assumptions about patient volume and staff capacity.

Hospital Patient Volumes and Characteristics Worksheet
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Estimate patient volume using national comparative data from the CAPC National Palliative Care Registry. Center to Advance Palliative Care, 2015.

Hospital Palliative Care Program Staffing Worksheet
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Project staffing FTE per discipline based on expected patient volumes. Center to Advance Palliative Care, 2015.

Community Palliative Care: Estimating Average Time/Visit to Determine Capacity
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Template and example for estimating time per patient visit for a new visit and for follow-up/subsequent visits, including a calculator for generating a weighted average visit time. Center to Advance Palliative Care, 2017.

Community Palliative Care: Estimating per Provider Visit Capacity
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Uses your time per visit estimate to project the number of visits a clinician will make per year, at different assumptions of weighted average hours per visit and annual visits per patient. Center to Advance Palliative Care, 2017.

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

Using service volume and staffing estimates to project program costs.

Hospital Impact Calculator

The Palliative Care Hospital Impact Calculator is designed to help you project overall cost savings for your inpatient palliative care consult service.

Community Palliative Care: Estimating Average Time/Visit to Determine Capacity
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Template and example for estimating time per patient visit for a new visit and for follow-up/subsequent visits, including a calculator for generating a weighted average visit time. Center to Advance Palliative Care, 2017.

Template for Estimating Staff Costs for a Visit and a Patient
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Model your assumptions about costs based on the variables of staff cost, staff time allocation, and patient volume.

Deep Dive into Understanding Costs

Webinar on projecting expenses for the community palliative care service.

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. Center to Advance Palliative Care, 2019.

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. Center to Advance Palliative Care, 2019.

Pricing Development Guide For Palliative Care Providers Seeking Payment Contracts
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Define program prices and determine the acceptability of prices offered by payers. Excerpted from the CAPC Payment Accelerator, reviewed 2018.

Translate service, staffing, cost, and billing revenue projections into a budget and business plan.

Building the Business Plan for Your Hospital Program

Building a budget and a business plan for the inpatient program. Includes business planning tools.

Hospital Palliative Care Business Plan Outline
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Training and a template for creating a business plan for your inpatient service. Center to Advance Palliative Care, 2015.

Budget Model Worksheet
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Annotated budget worksheet that can be customized based on your program's patient, service, and staffing assumptions. Center to Advance Palliative Care, 2015.

Building the Business Plan for Community-Based Palliative Care

Building a budget and a business plan for the community-based program. Includes business planning tools.

Community Palliative Care Business Plan Checklist
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Organize working assumptions about patient population, service model, and program staffing. Center to Advance Palliative Care, 2017.

Community Palliative Care Scenario Builder: Demonstrating the Interaction of Variables in Costs and Capacity
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Use this tool to organize your thinking on the budget and business plan, and to identify gaps that require more research.

Developing a Business Plan for Your Community-Based Program
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Guide to creating a community-based program business plan, including making the business case, defining value, and creating a work plan and budget.

Business Plans for Community-Based Palliative Care: Principles to Guide Development of a Sustainable Program

Presentation on business planning fundamentals.

Business Planning: Building Blocks of Community-Based Palliative Care Programs

In this Virtual Office Hour, ask about business planning for the new or growing community-based palliative care program, including understanding barriers and critical components for success.

Billing Revenue Estimator for Services Provided in the Community
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Overview of CMS rates for community-based services and template to estimate revenue.

Meet quality standards while optimizing efficiency in order to meet the assumptions you have laid out in your business plan.

Maximizing Palliative Care Program Efficiency

Improving productivity and efficiency to ensure team health and operating within budget.

Guidance for contracting with health plans or other entities to secure funding your palliative care program.

Payment Quick Tips: Payment Partnerships
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Introduction to building partnerships that can financially support palliative care programs. Center to Advance Palliative Care, 2019.

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. Center to Advance Palliative Care, 2019.

Tips for Hiring Lawyers and Actuaries-Financial Advisors
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Key roles when developing financial partnerships, including how to find and select these consultants.

Simple Rules for Making Alliances Work
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Harvard Business Review on developing and nurturing business relationships.

Advice from 2017 Accelerator Alumni
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Lessons from Accelerator alumni on building financial relationships with health plans.

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
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Legal obstacles impeding access to palliative care.

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

Template MOU
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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).

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

Sample Provider Education Document
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Developed by Blue Shield of California to ensure robust operations and quality within the palliative care provider network. Covers patient enrollment and disenrollment, billing and coding, and clinical care guidelines. Network management and legal can use this as a template to adapt to the needs of the organization.