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
Comprehensive Guidance
Best practices for systematically improving value in the care of people living with one or more serious illness, gleaned from health systems, health plans, and accountable care organizations (ACOs) from across the country.
Serious Illness Strategies: Driving Value in High-Need Populations
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A summary of implementation best practices for health plans and ACOs driving value in the care of high-need, seriously ill populations.
Use these tools for early, proactive identification and assessment to uncover potential areas of distress.
Proactive Patient Identification for Health Plans and ACOs: A Guide
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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
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Population health entities can use this list to proactively identify people with potentially unmet palliative care needs. Additional screening will be necessary.
How Medicare Advantage Could Address Pain Inequities for Black Patients Living with Serious Illness
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A summary of racial pain assessment and management disparities, and the opportunities for Medicare Advantage plans to mitigate them, even in the face of state opioid restrictions (Silvers et al.).
Purchaser Toolkit for High-Quality Serious Illness Care
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Tools for employers and other collaborators 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
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A summary of guidance from health plans on identifying palliative care services and ensuring those services are not subject to deductibles and co-pays.
Resources for identifying in-network or regional palliative care specialists, and for improving the communication and symptom management skills of all network providers.
Hospital Palliative Care Incentive Programs
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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.
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.
Care Managers in both health plans and ACOs are best positioned to identify unmet palliative care needs and coordinate across providers to align care with patient goals.
Screening and Assessment for Key Gaps in Care
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Screening questions and burden assessments for case management of people with serious illness.
Sample Script and Guidance: Cold-Calling Patients to Initiate Advance Care Planning
MEMBERS ONLY
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This script for care managers provides guidance and sample language to use when calling without a prior relationship to begin care planning for patients with serious illness.
The pioneering example of using palliative care principles in health plan case management. The program resulted in both high member satisfaction rates and cost savings.
Optimizing Care Management for People with Serious Illness
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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.
This Learning Pathway contains a comprehensive set of training and tools to help care managers address the unique needs of patients and families living with serious illness.
Learn from early adopters and jump-start population management efforts using recommended methods for patient identification, risk stratification, assessment, case management, and quality measurement.
Case Study: ProHealth Home-based Palliative Care in an ACO
MEMBERS ONLY
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ProHealth, a multi-specialty physician practice ACO, uses home palliative care for high-need patients.
Sharp Healthcare, an integrated network of hospitals and clinicians, incorporates a home palliative care intervention to meet the needs of complex patients.
Aetna's Compassionate Care Program: Sustained Value for Our Members with Advanced Illness
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An analysis of a health plan-led program of communication interventions and connection to palliative care and hospice, resulting in a significant decline in acute care utilization (Baquet-Simpson et al.).
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.
Case Study: Integrating Palliative Care Into Primary Care Workflows at Mayo Clinic
MEMBERS ONLY
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Use of palliative care-trained social workers to improve primary care for people living with serious illness. CAPC and the Accountable Care Learning Collaborative.
OSF, a large, faith-based health system, implements a systemwide Advance Care Planning Initiative. CAPC and the Accountable Care Learning Collaborative.
Anthem, a health plan operating across 14 states, includes palliative care structure and process measures in its quality incentive program for network hospitals.
Case Study: Advancing Coordinated Palliative Care during a Pandemic: Hudson Headwaters Health Network
MEMBERS ONLY
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A document detailing how Hudson Headwaters, a rural ACO covering 125,000 lives, deployed competent communicators to network facilities to significantly reduce avoidable hospital transfers.
A document detailing how Dean Health Plan, a large HMO in the midwest, successfully identified and engaged members in goals of care and advance care planning conversations.
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