Consensus Standards for Community-Based Palliative Care in California

Background

In 2016 the Coalition for Compassionate Care of California (CCCC) and Blue Shield of California convened individuals with expertise in palliative care, payment and policy advocacy, and health services research to form the “California Advanced Illness Collaborative” (CAIC). The mission of the CAIC was to improve the quality of care delivered to Californians with advanced illness with an initial strategy of increasing access to palliative care. The CAIC was funded, in part, by the Practice Change Leaders for Aging and Health (formerly Practice Change Fellows) program made possible by the generous support of the Atlantic Philanthropies and the John A. Hartford Foundation. 

The CAIC agreed to develop Consensus Standards for Community-Based Palliative Care in California. The CAIC undertook this work because the absence of community-based palliative care (CBPC) standards was seen as a critical impediment to the development, sustainability, and spread of CBPC services. Without a minimum set of standards, contracting between payers and providers was more challenging, as basic elements of contracts guiding CBPC delivery had to be developed from scratch. Further, health plan contracts might differ radically in terms of scope, staffing, eligibility requirements, and more, which created significant challenges for care providers with multiple health plan contracts.

To address these challenges, the CAIC developed a set of standards that are intended to facilitate development of contracts for delivering CBPC services.

About the Standards

The Consensus Standards for Community-Based Palliative Care in California (Standards) are based on the current understanding of best practices for CBPC, as put forth by multiple national organizations. The Standards are intended to complement and operationalize – not replace – expert consensus guidelines describing best practices. The CAIC goal was to generate a consensus document which could serve as a guide for both payers and palliative care providers. Key content areas of the Standards include eligibility, required services, provider qualifications, measurement and reporting, and payment models.

The Standards put forth a MINIMUM set of services that are to be delivered to a precisely defined patient population. The goal of the Standards is to identify a floor, based on best practices, which should be acceptable to any payer or provider. The minimum set of services are generally aligned with the terms of SB 1004, the California law that as of January 2018 requires Medi-Cal Managed Care health plans to ensure beneficiary access to palliative care. In practice, it is expected that contracts for delivering CBPC may include a broader set of services, a wider team of providers and additional patient populations. Similarly, the CAIC expects the listed MINIMUM metrics will be supplemented with other indicators that are of interest to payers, providers, or other stakeholders.

The CAIC believes that use of the Standards by payers and providers will reduce the time and energy required to construct a CBPC contract, as well as the variation in key contract components that makes implementation difficult for provider groups. Ultimately, it is hoped that the Standards will lead to the wider dissemination of high-quality CBPC.

The Standards were publicly released in March 2017 at CCCC’s 9th Annual Summit, as part of a panel discussion with Judy Thomas, JD (CEO, CCCC); N. Marcus Thygeson, MD, MPH (Blue Shield of California); James Mittelberger, MD, MPH (Director and Chief Medical Officer, Center for Palliative and Supportive Care, OPTUM); and Jill Mendlen, RN (Founder and CEO, LightBridge Hospice & Palliative Care and LightBridge Medical Associates).

The Standards were published on CCCC’s website on March 21, 2017, with a public comment period. The current document incorporates and addresses the feedback received.

DOWNLOAD THE CBPC CONSENSUS STANDARDS

The Standards in Practice

With grant funding from the California Health Care Foundation (CHCF), in 2018 the CCCC launched a demonstration project to test the efficacy and acceptability of the Standards when they are used as a foundation for contracts for delivering CBPC. Additional information about the demonstration project and its results, can be accessed here. 

A key finding of the pilot was that while the Standards work well as a basis for contracts for delivering CBPC, the choices health plans and providers make when operationalizing the Standards are just as important as the content of the standards themselves. Outcomes of the CBPC services that meet or exceed the minimums defined in the Standards are the result of both the extent to which health plans and providers adhere to the Standards and the policies and practices employed by providers and health plans to operationalize the Standards. For example, while the Standards specify a minimum population that should receive CBPC, the Standards do not address how that population will be identified, how eligibility will be verified, methods for promoting awareness and referrals by other health care providers, or methods for promoting acceptance by patients/families. Approaches to these and other operational issues will have tremendous impact on the number and characteristics of the population that ultimately receives services.

Because operational choices – which are not addressed in the Standards – are so critical, it is important to provide implementation supports to the health plans and palliative care providers that are using the Standards as a basis for CBPC contracts. Multiple supports are available from a variety of sources to assist health plans and providers in making informed choices about how they will use the Standards.

Additional resources are available here.