The CAPC Payment Accelerator: A Joint Virtual Workshop for Home-Based Care Teams-CAPC Payment Quick Tips

CAPC Payment Quick Tips - Payment Partnerships

Pdf Summary

The document provides guidance on securing financial support for palliative care services through strategic payment partnerships amid the privatization of Medicare and Medicaid. It highlights various potential partners, including Medicare Advantage Plans, Medicaid Managed Care Plans, Commercial health plans, Accountable Care Organizations (ACOs), practices in Bundled Payment Arrangements, and specialized care models like Oncology and ESRD Care Models.<br /><br />The document emphasizes starting with existing relationships to identify potential partners and conducting a needs assessment to understand local providers' challenges. Key factors for partners include improvements in patient experience, reduction in preventable utilization, meeting performance and quality metrics, and managing high-variable practice patterns.<br /><br />A "pilot" phase is recommended to test the partnership, allowing both parties to set expectations, gather data, and establish communication. The document advises maintaining alignment with the payer’s priorities, avoiding over-promising, and keeping regular performance checks.<br /><br />Calculating Return on Investment (ROI) is crucial for justifying the partnership. For instance, a palliative care program costing $400 per member per month but saving $2,000 in avoided hospital days yields an ROI of 4:1.<br /><br />The document also stresses the importance of securing legal and actuarial expertise to analyze data and negotiate contracts. Strategies for engaging with larger health systems or independent programs differ, with the latter possibly needing external expertise. Consistent communication, focusing on the problems partners aim to solve, and aligning goals are critical for sustainable relationships.<br /><br />Additional resources include toolkits and lessons from existing payer-provider partnerships, available from the Center for Medicare and Medicaid Innovation, emphasizing the need for a structured approach to build financially sustainable palliative care services.

Keywords

palliative care

financial support

payment partnerships

Medicare

Medicaid

Accountable Care Organizations

ROI

needs assessment

performance metrics

payer-provider partnerships