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Adopt policies and practices that adhere to minimum standards and improve quality of care.

Palliative care has the potential to yield improved clinical outcomes, better member experience of care, and lower cost of care. However, health plans can only attain these outcomes if they offer high-quality palliative care to their members. Palliative care is still a relatively new field compared to other medical specialties, with wide variations in services offered and quality achieved by palliative care providers. Health plans can enhance the likelihood of achieving improved outcomes by adopting policies and practices that adhere to minimum standards and encourage continuous improvement.



At the very least, start here


Take the next steps


Strive for excellence

Action Items

At the very least, start here

A. Monitor program performance and implement improvements 

  • Monitor program performance across all aspects of the quintuple aim (patient experience, patient outcomes, reducing costs, care team well-being, health equity) and disseminate the findings to provider partners to support quality improvement and promote appropriate referrals.

B. Adopt policies and practices that reduce variation in staffing models and scope of services delivered

  • Develop internal minimum standards based on the National Consensus Project Clinical Practice Guidelines and the Consensus Standards for Community-Based Palliative Care in California (see “Resources” below). Ensure that minimum standards specify capabilities that drive health, and experience and economic outcomes, such as a requirement that the clinical care team be available by phone, have access to health records, and can make visits when necessary on a 24/7 basis. 

  • Define qualifications and training prerequisites for the palliative care team and establish certification/accreditation prerequisites for palliative care provider organizations.


CAIC Consensus Standards for Community-based Palliative Care in California (Coalition for Compassionate Care of California)

Outlines minimum requirements for eligibility, scope of services, provider qualifications, measures, and payment models. It can be used as a starting point for developing minimum standards.


National Consensus Project Clinical Practice Guidelines for Quality Palliative Care, 4th Edition (National Coalition for Hospice and Palliative Care)

Detailed description of recommended practices for palliative care to inform benefit design.


Palliative Care Quality Collaborative

Monitor and benchmark quality of care delivered by palliative care providers.


Recommendations for Cross-cutting Quality Measures to Include in All Payment Models Involving Care for People with Serious Illness (PDF) (National Coalition for Hospice and Palliative Care)

Measures a plan might use to assess quality of palliative care program.


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