Resources for Health Plans and Population Management
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.
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.
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. Additional screening will be necessary.
An adaptation of Ariadne Conversation Guide to build into a health system EMR. Ariadne Labs and Integra ACO.
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.).
Toolkit for finding the right patients at the right time to address gaps in care.
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.
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 collaborators 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.
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.
Measures that can be used by payers and policymakers to ensure quality care for people living with serious illness.
Structures and processes that all hospitals and skilled nursing facilities need to assure access to high-quality care for people with serious illness.
How to engage clinicians in communication and symptom management skills training initiatives using CAPC's online courses.
The Role of Care Managers
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 questions and burden assessments for case management of people with serious illness.
Summary of care management strategies for members living with a serious illness, from preparing for the call to working with treating teams.
Advice from successful programs on how to make "cold calls" to patients identified to benefit from your services.
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.
Case Studies
Learn from early adopters and jump-start improvements with these examples.
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.
Training complex case managers in communication skills and deprescribing. CAPC and the Accountable Care Learning Collaborative.
Use of screening to risk-stratify patients for palliative care based on need. CAPC and the Accountable Care Learning Collaborative.
Mercy Health, a 135,000 lives ACO, added in palliative care consultations virtually to the top 5% of its virtual complex care patients.
An excerpt from CAPC's Home-based Guide, at-a-glance review of program models.
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.
Faculty
-
Diane E. Meier, MD, FACP, FAAHPM
Founder, Director Emerita and Strategic Medical Advisor, Center to Advance Palliative Care
-
Allison Silvers, MBA
Chief Health Care Transformation Officer
-
Torrie Fields, MPH
Founder and Managing Partner
TF Analytics -
Tom Gualtieri-Reed, MBA
Partner
Spragens & Gualtieri-Reed
