Health Plan Medical Directors: Supporting Best Care for Members with Serious Illness

Last Reviewed: March 4, 2019

Symptom management, communication about care preferences, and family support result in fewer crises and less reliance on emergency department and hospital care for people with serious illness.

Health plan medical directors can improve quality of care for members with serious illness through collaboration with both treating clinicians and health plan care managers to help match services to needs.

Download a course catalog with information about continuing education credits and ABIM MOC points for all CAPC courses here.

What’s in the Toolkit

Strategies for health plans and Accountable Care Organizations (ACOs) to promote access to palliative care services through collaboration and contracting with providers.

Communicating with Treating Clinicians: How Medical Directors Can Support Best Care for the Seriously Ill

Last Updated: October 19, 2017

Guidance for collaborating with treating providers to ensure that members who would benefit receive palliative care.

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Serious Illness Strategies

Last Updated: February 3, 2019

The case for health plans and accountable care organizations to advance access to quality palliative care, and practical guidance for implementation. Center to Advance Palliative Care, 2017.

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An In-Depth Look At Palliative Care And Its Services

Last Updated: January 15, 2015

Defining palliative care, which patients need it, how it is delivered, and how palliative care differs from hospice.

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Introduction to Palliative Care in the Community

Last Updated: January 15, 2015

Defining community-based palliative care: which patients need it, how it is delivered, and how it differs from inpatient palliative care.

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National Consensus Project for Quality Palliative Care, 4th edition

Last Updated: January 29, 2019

The National Consensus Project (NCP) Clinical Practice Guidelines are the national standard for high quality palliative care. National Consensus Project for Quality Palliative Care, 2018.

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Improving the Care of Serious Illness Though Innovative Payer-Provider Partnerships- A Palliative Care Toolkit and Resource Guide

Last Updated: January 29, 2019

Designing a payer-based program that ensures specialized support for members with serious illness. Center to Advance Palliative Care, 2016.

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Identifying Older Adults with Serious Illness- A Critical Step Toward Improving the Value of Health Care

Last Updated: February 6, 2019

An evidence-based algorithm for identifying members at high risk for subsequent hospitalization. Kelley AS, Covinsky KE, Gorges RJ, et al. Identifying Older Adults with Serious Illness: A Critical Step Toward Improving the Value of Health Care.Health Serv Res. 2017;52(1):113-131. doi: 10.1111/1475-6773.12479.

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Care Delivery and Coordination in an Accountable Care Environment

Last Updated: February 3, 2019

Improving value by integrating palliative care into ACO strategy. Block S, Jackson V, Lee T. Health Affairs Blog, February 2014.

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NCCN Clinical Practice Guidelines for Oncology: Palliative Care

Last Updated: February 3, 2019

An integrated, evidence-based suite of tools developed by the National Cancer Care Network designed to help improve the quality of cancer care.

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NHPCO Standards of Practice for Pediatric Care and Hospice

Last Updated: February 3, 2019

An overview of the standards for high-quality palliative care for children.

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Concurrent: Negotiating Conflicts between Palliative Care and Other Providers: Why Can’t We All Just Get Along?

Last Updated: February 28, 2019

2010 CAPC National Seminar presentation. Presenter: Robert Arnold, MD

Clinical guidance specific to the population of people with serious illness.

Symptom Management

Last Updated: March 4, 2019

Training curriculum and clinical tools for assessing and managing five common symptoms in patients living with serious illness.

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Course 1: Comprehensive Pain Assessment

Last Updated: July 1, 2019

Conducting a comprehensive pain assessment to guide safe and effective treatment.

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Course 3: Patient Factors that Influence Prescribing Decisions

Last Updated: July 1, 2019

Patient and family factors that influence prescribing decisions for patients with serious illness.

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Palliative Care Guidelines and Order Sets (ICSI)

Last Updated: February 3, 2019

A comprehensive approach to addressing the pain and symptoms of serious illness. Prepared by the Institute for Clinical Systems Improvement, 2007.

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Support both treating clinicians and health plan care managers to elicit and address what matters most to members and families.

Supporting the Family Caregiver: The Burden of Serious Illness

Last Updated: March 10, 2016

Assessing and supporting caregivers of people with serious illness.

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Advance Care Planning Conversations

Last Updated: November 12, 2015

How to initiate and conduct conversations about advance care planning.

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Clarifying Goals of Care

Last Updated: January 15, 2015

Strategies for eliciting patient goals and preferences to inform treatment decisions.

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Advance Care Planning Resources (CCCC)

Last Updated: March 1, 2019

A suite of tools developed by the Coalition for Compassionate Care of California, including conversation guides and several advance directive forms, the latter also in Spanish.

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The Human Connection of Palliative Care: 10 Steps for What to Say and Do

Last Updated: February 3, 2019

Ten important steps for improving communication between clinicians and patients/families. NOTE: This video does not provide CE credits.

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