by Audrey Kinsella, MA, MS
The email invitation to a webcast on palliative care piqued my interest. As soon as I registered, however, my thoughts turned predictably to questions I always get when writing about new healthcare delivery services. Is it workable? Who pays for it? Will home care adopt it?
My worries were immediately dispelled by the title and description. "Introducing the Palliative Care Payer Toolkit: How Payers are Supporting Palliative Care." Information would be based on a year's work undertaken by the Center to Advance Palliative Care, in partnership with the National Business Group on Health and the California HealthCare Foundation. The goal was to identify the ways in which payers can support palliative care for their members living with serious illnesses and to assist payers and providers in partnering to address the needs of this population.
Not a palliative care provider yet? Read on...
This summary of the webcast will be of interest to readers thinking about developing a palliative care program. But at the end there is also information for current providers about one new payment option for palliative care service delivery that is now underway from Medicare.
Emily Warner, JD, Senior Policy Analyst, CAPC
The first of two presenters involved with this project began by noting the growing need for targeted, comprehensive care services for long-term chronic disease patients. Anyone working in healthcare already knows this, of course, but Ms. Warner's information about an extensive range of tools to help provide such care came as a welcome surprise.
A toolkit developed during the project is made up not of devices but of new constructs for program building. These include directives on goal setting, including getting informed by the patient and family about what palliative care outcomes are important to them; and assessments of family caregiver support, such as their capacity and willingness to provide supplemental care. Such an assessment, she asserted, may lead to designing targeted training and support for them.
This toolkit is available at no cost at http://www.capc.org/payertoolkit/toolkit.pdf.
(Editor's note: For a recent definition of palliative care, please see Audrey Kinsella's 2012 HCTR article, "Palliative Care at Home: New Opportunity for Home Health Providers.")
Tom Gualtier-Reed, MBA
A healthcare consultant with Spragens & Associates, LLC, Mr. Gualtier-Reed urged listeners to take the next steps, now that the tools for building palliative care programs have been identified. He explained that entities that want to start palliative care programs should begin by "setting the context," that is, identifying other players — patients, families, financiers, healthcare providers — who share common objectives.
He said that all of them need to partner together to achieve a common objective, which is to better the quality of these patients' lives on a 24/7 basis. By partnering, there may even be a new care model that develops to help manage common challenges. To name just a few: the high cost of care; the need to provide social, physical, and emotional support; and getting a skilled workforce (comprising a range of providers) specifically trained to care for the seriously ill.
Gualtier-Reed said some payers are supporting palliative care program development by providing focused care manager training; by changing medical policies and so that member benefits allow for curative treatment and hospice care; and by covering more home-based palliative care visits delivered by interdisciplinary team members.
Some payers are also piloting different models for home-based palliative care programs and instituting per-member per-month fees to manage seriously ill populations. These projects are forseeeing the value of providing patients with the support necessary to live safely and comfortably at home. Examples of palliative care work by Aetna, Excellus BlueCross BlueShield, and Highmark, Inc. are provided in chapter 3 of the Toolkit.
Existing Medicare payments for home-based palliative care
A new payment plan for palliative care programs is the Medicare Care Choice Model (MCCM), established under section 115A of the Social Security Act. It will test new models of care for certain hospice-eligible Medicare and dual eligible beneficiaries to improve care coordination and case management, beneficiary satisfaction, and quality of care, as well as reduce Medicare expenditures. Details on eligibility of Medicare- and Medicaid-funded hospice patients are provided at: http://innovation.cms.gov/Files/x/MCCM-RFA.pdf
The MCCM will undergo a "period of performance" for three years. CMS expects to announce selected participants by the fall of 2014 and expects participants to begin delivering services under the Model no later than 180 days after the announcement. CMS's objective in testing the Model is to address research questions focused on whether the Model would:
The MCCM web page is available at: http://innovation.CMS.gov/initiatives/Medicare-Care-Choices/ It provides details on provider eligibility and application submissions. Through selected hospices, CMS expects to enroll 30,000 beneficiaries over the three-year period.
©2014 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. editor@homecaretechreport.com