Lessons learned from payer-provider partnerships for community-based palliative care
- Collection:
- Health Policy and Services Research
- Series Title(s):
- Issue brief (California HealthCare Foundation)
- Author(s):
- Kerr, Kathleen, author Meyers, Kate, author
- Contributor(s):
- California HealthCare Foundation, issuing body.
- Publication:
- [Oakland, Calif.] : California Health Care Foundation, October 2018
- Language(s):
- English
- Format:
- Text
- Subject(s):
- Community Health Services -- organization & administration Palliative Care -- organization & administration Eligibility Determination Health Care Costs Insurance, Health, Reimbursement Medicaid Outcome Assessment (Health Care) Palliative Care -- economics Private Sector Public Sector Public-Private Sector Partnerships Referral and Consultation State Government Humans United States
- Genre(s):
- Technical Report
- Abstract:
- Despite evidence of the benefits of community- based palliative care (CBPC) and data indicating that our current capacity is insufficient to meet the need, growth of these services has likely been slowed by the lack of adequate, defined funding streams. To address this challenge, from 2014 to 2017, the California Health Care Foundation (CHCF) supported a planning and implementation process for six teams of payer and provider organizations committed to strengthening and spreading CBPC services in California. Participating providers included large academic medical centers, hospices, and a specialty palliative care practice, while the payers included national insurers, regional insurers, and a Medicaid managed care plan. Payer-provider teams participated in a six-month planning process during which they developed operational and financial plans for delivering palliative care services in community settings (clinics, patient homes, and tele-visits), followed by a 24-month implementation phase where contracts were executed and services were launched. This kind of collaboration between payers and providers is an emerging trend in CBPC, and our grantees were among the first to participate in such efforts. In this series, lessons learned from the initiative that address the process of developing and enacting an agreement to deliver CBPC are reviewed. Data sources include semistructured interviews conducted with 13 people who participated in the initiative, progress reports submitted to CHCF by participating teams, and discussions that occurred in grantee meetings and webinars. The lessons are organized into eight topics: (1) Initial engagement, including useful information to gather from potential partners; (2) Defining the eligible population, including how eligibility criteria and environmental factors might impact the staffing model, focus, and cost of providing CBPC; (3) Promoting appropriate referrals, including strategies that payers and providers might use; (4) Service design and operational issues, such as the need to be transparent about expectations and to develop detailed plans that describe both the care model and the administrative processes; (5) Payment issues, including different payment mechanisms used by participants; (6) Metrics and assessing impact, including a list of the metrics used by the participating teams; (7) Monitoring and modifications, including issues related to transitioning from a pilot to a sustained program; (8) Relationship issues, including participant observations regarding behaviors that were highly valued and behaviors that created tension.
- Copyright:
- Reproduced with permission of the copyright holder. Further use of the material is subject to CC BY-NC-ND license. (More information)
- Extent:
- 1 online resource (1 PDF file (21 pages)).
- NLM Unique ID:
- 101744595 (See catalog record)
- Permanent Link:
- http://resource.nlm.nih.gov/101744595