Piloting Use of Consensus Standards in Payer-Provider Contracts

Building Consensus


The growth of “payer-provider partnerships” to deliver community-based palliative care (CBPC) has been hindered by an incremental approach of creating contracts one by one, sometimes with wide variation in the target population or services.

In 2015, to address these challenges, the Coalition for Compassionate Care of California and Blue Shield of California created the California Advanced Illness Collaborative (CAIC), a workgroup of health plans, CBPC providers, and other stakeholders that developed Consensus Standards to inform CBPC payer-provider contracts.

The Standards, which are aligned with the current specifications of SB 1004, provide minimum standards regarding eligible patients, care team composition, clinical services, payment models, and metrics. Under the pilot, a cohort of up to six health plans and up to eight provider organizations will partner to deliver CBPC services that meet or exceed the Standards in two regions of California.

Quantitative and qualitative evaluation will assess acceptability of the Standards to payers and providers; patients’ and families’ experiences with CBPC services received; quality outcomes; use/fiscal outcomes; and characteristics of CBPC services. If successful, the pilot could make future contracting efforts easier and encourage more payers to offer CBPC as a benefit for seriously ill patients.