Background

This is a guide to help California Medi-Cal managed care plans (MCPs) assess and optimize a palliative care (PC) program that meets or exceeds the state’s requirements stemming from Senate Bill 1004 (SB 1004) to ensure access to PC for eligible members. The other main audience is PC provider organizations that are, or might become, contracted provider partners for these MCPs.

This guide is a collection of curated resources that have served California’s Medi-Cal MCPs and their PC partners best, along with new resources that the California Health Care Foundation (CHCF) has assembled from the recommendations and materials (e.g., job descriptions and process workflows) of successful MCP-PC partnerships.

The five sections of the guide are organized in a stepwise progression, from designing core structures and processes to monitoring quality and improving operations. However, the sections and their related resources can be used in any order.

All sections except for Section B address the MCP role in managing its state-required PC program. Section B provides guidance and resources for the PC provider organization specifically. The whole guide is helpful for both sides of the MCP-PC provider partnership. Section E, in particular, focuses on program growth and quality improvement, so it is meant to serve both partners in their work together.

• A: Define (or refine) the MCP program
• B: Ensure readiness (and ongoing development) of the PC provider organization
• C: Develop (or optimize) MCP program operations
• D: Define (or refine) strategies to identify and engage MCP members
• E: Strengthen the partnership, improve quality, and monitor operations

For a complex clinical service like palliative care, the work of collaboration and improvement should be continuous. To allow for this ongoing progress, the guide defines “minimum” capabilities that all users should consider adopting, as well as “enhancements” for users that wish to optimize and elevate their programs.

A version of this guide is available for download (PDF); this contains the descriptions of each essential element and the “minimum” and “enhancement” descriptions of capabilities, but refers back to this web-based toolkit for all tools and links.

Acknowledgments

CHCF offers appreciation and gratitude to the MCPs, PC provider organizations, and palliative care expert organizations for their contributions to this guide, and for their efforts in the field of palliative care.

• Anthem
• Aspire Health
• Blue Shield of California / Blue Shield Promise
• California State University Shiley Haynes Institute for Palliative Care
• Center to Advance Palliative Care
• Coalition for Compassionate Care of California
• Health Net
• Hospice of Santa Cruz County
• Housecall Providers (Oregon)
• Inland Empire Health Plan
• L.A. Care Health Plan
• LightBridge Hospice & Palliative Care
• Molina Healthcare
• National Hospice and Palliative Care Organization
• Partnership HealthPlan of California
• Providence Health
• ResolutionCare
• Roze Room
• Snowline

About the Authors

Hunter Gatewood is a consultant and teacher in leadership and improvement with his company, Signal Key Consulting. His connection to palliative care stems from experience in social work case management with high-mortality populations, and more recently in serving palliative care providers in quality improvement and systems integration efforts.

Kathleen Kerr is a health care consultant in private practice in Northern California. Her work is focused on promoting the development of sustainable, quality palliative care programs, with particular emphasis on services that operate in rural areas and those that serve Medicaid enrollees.