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Payer-Provider Partnerships to Expand Community-Based Palliative Care

CHCF funded pairs of payers and providers to develop novel plans for how to deliver and reimburse high-quality, community-based palliative care to patients with serious illness. Now implementation projects are underway.

Many studies have shown that patients who receive palliative care experience better quality of life and live longer with fewer symptoms of illness. Payers and providers are recognizing this value and collaborating on new ways to deliver and pay for community-based palliative care.

To promote and support these collaborations, CHCF provided planning grants to pairs of payers and providers engaged in developing operational and financial plans for delivering palliative care services in the community setting. These grants resulted in service proposals, including details of eligibility criteria, reimbursement and delivery mechanisms, and other considerations.

The selected partnerships, awarded through an RFP process in 2014, are each listed by the lead agency with partner(s) and regional focus area:

  1. California Pacific Medical Center with Sutter and Brown & Toland (San Francisco)
  2. CareChoices Hospice & Palliative Services with HealthNet (Orange County, Long Beach, and South Los Angeles)
  3. Community Regional Medical Center with Humana (Fresno)
  4. LightBridge Hospice & Palliative Care with HealthNet (San Diego)
  5. Optum Palliative & Hospice Care with UnitedHealth (Orange County)
  6. Partnership Health Plan with various palliative care providers (Northern California)
  7. Rady Children's Hospital with HealthNet (San Diego)
  8. SCAN Health Plan with MemorialCare Medical Group and Monarch (Orange County)
  9. UCLA with Anthem (Los Angeles)
  10. UCSF with Hospice by the Bay and Blue Shield (San Francisco)

A summary document of the plans that were developed is available as a Document Download.

In September 2015, two-year implementation grants were made to six partnerships:

  1. CareChoices Hospice & Palliative Services with HealthNet (Orange County, Long Beach, and South Los Angeles)
  2. LightBridge Hospice & Palliative Care with HealthNet (San Diego)
  3. Partnership Health Plan with various palliative care providers (Northern California)
  4. Rady Children's Hospital with HealthNet (San Diego)
  5. UCLA with Anthem (Los Angeles)
  6. UCSF with Hospice by the Bay and Blue Shield (San Francisco)

Available under Related CHCF Pages below are a toolkit that highlights examples of successful payer-provider collaborations from across the country and outlines best practices; and a report that demonstrates how California's health plans are developing palliative care benefits that allow for earlier access to services.

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