ABOUT THE CAIC
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 is to improve the quality of care delivered to Californians with advanced illness, with an initial strategy of increasing access to palliative care.
The California Advanced Illness Collaborative (CAIC) has been funded, in part, by the 2016 Practice Change Leaders (PCL) program made possible by the generous support of the Atlantic Philanthropies, a limited life foundation, and the John A. Hartford Foundation. The PCL program is under the direction of Eric A. Coleman, MD, MPH. To learn more about the program, please visit www.changeleaders.org.
Development of Consensus Standards for Community-Based Palliative Care (2016-2018)
The first major initiative of the CAIC was the development of Consensus Standards for Community-Based Palliative Care in California. The goal of the Standards was to identify an agreed-upon set of basic standards (floor) for community-based palliative care (CBPC), based on best practices, which could serve as a guide for both payers and providers.
The absence of CBPC standards created difficulties for both payers and providers, and ultimately impeded 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 CBPC delivery had to be developed from scratch. 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. These standards build off of prior work in California led by the California Health Care Foundation (CHCF).
The CAIC Standards are based on the current understanding of best practices for CBPC, as put forth by multiple national organizations. The CAIC goal was to operationalize some aspects of existing policy documents and guidelines that address best practices in CBPC – elements that are often included in service delivery contracts.
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). A video of the presentation is available below.
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.
Pilot to test the Consensus Standards for Community-Based Palliative Care (2018-2020)
With grant funding from the California Health Care Foundation, the CAIC is currently working to pilot test the efficacy and acceptability of the Consensus Standards for Community-Based Palliative Care in California when they are used as a foundation for contracts for delivering community-based palliative care.
Currently there is wide variation among community-based palliative care (CBPC) services in terms of target populations, eligible criteria, scope of services, staffing requirements and metrics used to assess quality and impact. This variability makes it difficult for health plans that are interested in offering CBPC benefits to find published evidence of impact that was generated with a patient population or service model that matches their own situation. Single plan-single provider pilots of CBPC programs tend to enroll very small numbers of patients, and thus have often not generated meaningful information about CBPC outcomes. As a result, many plans do not offer CBPC benefits, resulting in tens of thousands of seriously ill Californians having no access to the CBPC services they need.
Further, providers often need multiple contracts to generate enough volume to support the infrastructure required to provide CBPC, but extensive variation in the components of such contracts makes implementation extremely difficult. A key lesson from CHCF’s Payer-Provider Partnership Initiative is that CBPC providers often manage multiple contracts, each of which could (and very often do) differ in terms of patient population, scope of service, expected duration, required metrics, and care model/staffing requirements. This variation across payer sources creates enormous burdens on providers’ clinical and administrative teams, and threatens the sustainability of these services.
The goal of the pilot is to test the CAIC Consensus Standards for Community-Based Palliative Care with a cohort of health plans and community-based palliative care providers that deliver services that meet or exceed the Standards in two regions of California (Los Angeles and Sacramento) with each payer contracting with multiple providers, and each provider contracting with multiple payers. Different aspects of the Standards will be evaluated from the perspective of payers and providers, as well as patient and family satisfaction with the CBPC delivered. The desired outcome is to refine the Standards based on the lessons learned during the pilot and to develop a useful, practical body of information that can be applied to existing or new payer-provider contracts for CBPC, within California and nationally. Ultimately, CCCC hopes it will result in an easier contracting process, where payers and providers have a predetermined starting point and greater confidence in expected outcomes.
Palliative care is patient- and family-centered care that prioritizes quality of life by anticipating, preventing and treating symptoms associated with serious illness while addressing physical, intellectual, emotional, social and spiritual needs. Generally, palliative care is provided by an interdisciplinary team of physicians, nurses, social workers, chaplains and other specialists working together to provide patients an extra layer of support, regardless of age or stage of their serious illness. Studies show palliative care results in better patient and family satisfaction, improved home safety and medication management, and can be provided alongside curative treatment, helping patients, families and caregivers through challenging times.
CBPC Resource Page | CHCF
Snapshots of Palliative Care Practices | CHCF/CCCC
SB 1004 Resource Center | CHCF