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Adopt a bundled payment model for home-based and outpatient palliative care.
Increase utilization of palliative care.
Uptake of palliative care, along with its associated benefits, only happens when people with serious illness understand what palliative care is, how it can complement their other medical services, and the ways to access it.
Health plans can play a pivotal role in generating and sustaining this demand through community engagement efforts that raise awareness and establish trust in palliative care. They can also educate case managers and health care providers about the benefits of palliative care and implement systems for identifying people who could benefit from these services.
UPTAKE
THE ESSENTIALS
At the very least, start here
PROGRESSING FURTHER
Take the next steps
SETTING THE STANDARD
Strive for excellence
Action Items
At the very least, start here
Use inclusive eligibility criteria. For example, expand the eligible population for home-based palliative care services beyond the minimums specified in Medi-Cal policy guidance.
Provide training to clinical and non-clinical plan staff regarding the benefits of palliative care, and how to effectively communicate its value.
Implement a four-part approach to identify appropriate members:
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Utilize claims and administrative data to proactively identify individuals with serious diagnoses and unmet symptom burden or insufficient social supports.
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Integrate member identification into the workflows of plan care managers.
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Collaborate with hospital-based clinicians and staff, including discharge planners.
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Promote referrals from healthcare providers who care for a substantial number of seriously ill members, such as oncologists or cardiologists.
Offer resources that describe palliative care using culturally appropriate phrasing and, when necessary, in multiple languages.
Toolkit
Care Managers: Addressing the Unique Needs of Patients with Serious Illness (Center to Advance Palliative Care)
Online courses and resources to help care managers meet the needs of members with serious illness.
Online Course
Essential Care Management Training for Health Plans (Care Excellence)
Foundational, advanced, and leadership training for care managers working at health plans. Online and in-person offerings.
Video Series
Introducing Palliative Care Video Series (Coalition for Compassionate Care of California)
Video series and supporting materials to help case managers and clinicians become more comfortable with describing palliative care or responding to common questions or concerns about palliative care when offering it to their members or patients.
Memo
Recommendations for Identifying the Population with Serious Illness (Center to Advance Palliative Care)
Brief description of strategy for a data-based approach to identifying members who might benefit from palliative care.
Online Course
Palliative Care for Care Managers (California State University Shiley Haynes Institution for Palliative Care)
Online course for care managers that introduces palliative care, evidence-based therapeutic approaches, determining who qualifies, and effectively communicating options with members.