Resources for Health Plans
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
Population Identification and Assessment
Use these tools for early, proactive identification and assessment to uncover potential areas of distress.
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.
Population health entities can use this list to proactively identify people with potentially unmet palliative care needs.
Screening questions and burden assessments for case management of people with serious illness.
Specialty Palliative Care Services and Benefits
Guidance and tools to ensure access to specialty palliative care services for members living with serious illness.
A summary of implementation best practices for health plans and ACOs driving value in the care of high-need, seriously ill populations.
Recommended capabilities and competencies for payers and policymakers to contract with quality programs.
Examples of benefits currently in use, focusing on interventions of less than three months.
Specific actions for plans looking to improve value-based design or expand supplemental benefits. Health Affairs, July 2018.
A streamlined calculator for modeling return on investment based on home-based palliative care program assumptions.
Presentation to Society of Actuaries on calculations for case rate payment.
Tools for employers and other stakeholders to specify required benefits and network competencies. Catalyst for Payment Reform and Center to Advance Palliative Care, 2018.
A summary of guidance from health plans on identifying palliative care services and ensuring those services are not subject to deductibles and co-pays.
A resource providing a sample provider-sponsored health plan's ACP payment policy.
This document provides a sample provider-sponsored health plan's palliative care payment policy.
Provider Network Strategies
Resources for identifying in-network or regional palliative care specialists, and for improving the communication and symptom management skills of all network providers.
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.
Measures that can be used by payers and policymakers to ensure quality care for people living with serious illness.
How to engage clinicians in communication and symptom management skills training initiatives using CAPC's online courses.
