Access to palliative care services results in improvement on quality measures, reduction in spending, and relief of suffering for members and their families. In addition to the general guidance and case studies available in CAPC’s Population Management and Palliative Care toolkit, health plans can use the resources below to develop new programs and benefits for members with serious illness while simultaneously driving improvements throughout their provider network.

What’s in the Toolkit

Use these tools for early, proactive identification and assessment to uncover potential areas of distress.

Optimizing Care Management for People with Serious Illness

This on-demand webinar features two leading health plans that have adapted care management staff and processes to meet the unique needs of members/patients with serious illness.

Proactive Patient Identification for Health Plans and ACOs: A Guide

Best practices in how to use data sources, such as claims or medical records, to identify patients who are most likely to benefit from palliative care.

Sample Diagnoses Codes to Identify Patients Living with Serious Illness

Population health entities can use this list to proactively identify people with potentially unmet palliative care needs.

Screening and Assessment for Key Gaps in Care

Screening questions and burden assessments for case management of people with serious illness.

Guidance and tools to ensure access to specialty palliative care services for members living with serious illness.

Serious Illness Strategies: Driving Value in High-Need Populations

A summary of implementation best practices for health plans and ACOs driving value in the care of high-need, seriously ill populations.

Home-based Palliative Care Program Credentialing Recommendations

Recommended capabilities and competencies for payers and policymakers to contract with quality programs.

Short-Term Home-Based Palliative Care Benefits

Examples of benefits currently in use, focusing on interventions of less than three months.

Medicare Advantage Flexibility: Improving Care for Seriously Ill Beneficiaries

Specific actions for plans looking to improve value-based design or expand supplemental benefits. Health Affairs, July 2018.

Home-Based Palliative Care ROI Calculator

A streamlined calculator for modeling return on investment based on home-based palliative care program assumptions.

Building an Actuarial Model for Home-Based Palliative Care

Presentation to Society of Actuaries on calculations for case rate payment.

Purchaser Toolkit for High-Quality Serious Illness Care

Tools for employers and other stakeholders to specify required benefits and network competencies. Catalyst for Payment Reform and Center to Advance Palliative Care, 2018.

Eliminating Cost Sharing for Palliative Care and Advance Care Planning

A summary of guidance from health plans on identifying palliative care services and ensuring those services are not subject to deductibles and co-pays.

Sample ACP Payment Policy

A resource providing a sample provider-sponsored health plan's ACP payment policy.

Sample Palliative Care Payment Policy

This document provides a sample provider-sponsored health plan's palliative care payment policy.

Resources for identifying in-network or regional palliative care specialists, and for improving the communication and symptom management skills of all network providers.

Addressing Health Disparities in End-of-Life Care

Presentation from the Center for Medicare and Medicaid Innovation featuring CAPC, delivered to participants in the hospice benefit component of the Value-Based Insurance Design (VBID) Model.

Hospital Palliative Care Incentive Programs

A blog describing two straight-forward and effective programs, one at Anthem Inc and one Highmark Blue Cross Blue Shield, incentivizing access to palliative care in network hospitals.

Recommended Quality Measures

Measures that can be used by payers and policymakers to ensure quality care for people living with serious illness.

Tips for Network Provider Engagement in Training

How to engage clinicians in communication and symptom management skills training initiatives using CAPC's online courses.

Innovative Approaches to Caring for Complex Patient Populations: The Community Paramedicine Experience

This on-demand webinar shows how Commonwealth Care Alliance addresses patient needs 24/7 through a partnership with local paramedicine services.

Improving operations and training clinical staff to identify, stratify, and meet the needs of patients living with serious illness at the population level. Includes 24 resources.
Toolkit for finding the right patients at the right time to address gaps in care. Includes 56 resources.
This toolkit provides online courses and resources for care managers to meet the needs of patients with serious illness. Includes 14 resources.

See all 47 Toolkits

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