The CAPC Payment Accelerator: A Joint Virtual Workshop for Home-Based Care Teams-CAPC Payment Arrangement Option

CAPC Payment Arrangement Option
Pdf Summary
The document outlines various payment arrangements for community-based palliative care, focusing on the fiscal impact, administrative burden, and other logistical factors. The payment options are designed for non-hospice community-based palliative care, defined as care provided outside hospital settings through home care and collaborations with service agencies, aiming to maintain quality of life and optimize function for patients at their residence.<br /><br />### Payment Options Overview:<br /><br />1. **Specialized Fee Schedule under Fee-for-Service (FFS)**<br />   - **Description**: Providers negotiate higher payment rates for specific services, requiring payer-created special codes for billing.<br />   - **Pros**: Limited administrative burden, no downside risk, and simple contract negotiations.<br />   - **Cons**: Limited upside potential, no additional service flexibility, and no access to broader health data.<br /><br />2. **FFS with Shared Savings**<br />   - **Description**: Providers are paid per service and receive part of the savings if population spending is below targets.<br />   - **Pros**: Potential for shared savings, access to additional data, no downside risk.<br />   - **Cons**: Complex agreements, shared savings spread thinly across many providers, limited access to negotiation data.<br /><br />3. **FFS with Shared Savings/Losses**<br />   - **Description**: Similar to shared savings, but providers also share the losses if spending exceeds targets.<br />   - **Pros**: Potential for greater savings, additional data, limited downside risk.<br />   - **Cons**: Complex negotiations, potential liability for unrelated provider losses, negotiation data may be unavailable.<br /><br />4. **Add-on Fee (Care Management Fee)**<br />   - **Description**: Monthly fixed fee for non-clinical services, alongside regular clinical service payments.<br />   - **Pros**: Additional revenue, simple contracts, predictable income, no downside risk.<br />   - **Cons**: Limited service control, risk of inadequate payment rates, narrow service coverage.<br /><br />5. **Case Rate (Partial Capitation)**<br />   - **Description**: Fixed monthly payment for a set of services, with possible shared savings/losses.<br />   - **Pros**: Service delivery flexibility, predictable income, straightforward contracts.<br />   - **Cons**: Limited control outside defined services, risk of inadequate rates, administrative challenges.<br /><br />6. **Lump Sum Payment**<br />   - **Description**: Payment for services over a time period, either per session or annually.<br />   - **Pros**: Flexible service delivery, potential for increased revenue, simple contracts, predictable income.<br />   - **Cons**: Limited upside savings, high-risk patient budget concerns, limited provider control.<br /><br />7. **Bundled Payment/Episode-Based**<br />   - **Description**: Fixed payment for all services over a defined period, with shared savings/losses.<br />   - **Pros**: Additional revenue, strong provider cooperation incentives.<br />   - **Cons**: Potential losses, complex negotiations, administrative and reporting burdens.<br /><br />8. **Full/Global Capitation**<br />   - **Description**: Provider takes on all financial risks for a population, with fixed payments for all services.<br />   - **Pros**: Significant service delivery flexibility, potential for substantial savings.<br />   - **Cons**: Complex negotiations, full financial risk, administrative challenges.<br /><br />The document concludes by advising against providers taking on full global capitation due to the high risk associated with the variability in the seriously ill population. Instead, collaboration with other providers under different models is recommended.
Keywords
community-based palliative care
payment arrangements
fiscal impact
administrative burden
non-hospice care
fee-for-service
shared savings
care management fee
case rate
global capitation