Developing Partnerships with Payers
This is the ninth course in the 11-part series of Building a Community-Based Palliative Care Program. You can take this single course or the entire series.
Fee-for-service billing under Medicare is unlikely to generate sufficient revenue to sustain your community-based palliative care program. In this course you will learn how to develop partnerships with payers and at-risk health systems, speak their language, craft a convincing proposal, and negotiate rates that can create a consistent revenue stream for your palliative care program. In addition, partnerships can provide a strong referral base of patients who otherwise may not have benefitted from your program’s services.
Developing Partnerships with Payers is a resource-packed five-hour course written by Torrie Fields, MPH, an expert in payer/provider partnerships. You will learn the payer’s rationale for developing a partnership to provide palliative care, and language to include in your business case to help you secure a contract. Information on how to present a compelling case to payers to expand access to your services and negotiate reimbursement for your services is also presented. In addition, the course includes several resources including a glossary of terms and the downloadable Community-based Palliative Care Return on Investment Calculator so you can demonstrate the potential ROI of your program in a language that payers understand.
This course is ideal for clinical and administrative leaders interested in learning more about developing partnerships with payers and reimbursement models who work in:
- Health systems
- Physician offices and clinics
- Home health agencies
- Social service organizations
- Accountable care organizations
- Medical homes
- And other organizations interested in developing a program or partnering to provide community-based palliative care
Join the Interest List!
|Location:||Completely online, available 24/7|
|Continuing education:||5 hours OR Click HERE for CME Credit Info*|
|Requires:||Computing skills sufficient to complete graduate work, access to a computer with an Internet connection|
|Is ideal for:||Palliative care professionals interested in or responsible for program development, billing or budgeting|
|Provides:||Insights and in-depth knowledge to help you develop and sustain a successful partnership with a payer to provide community-based palliative care|
|Detailed FAQ:||Click HERE.|
The Doctors Company designates this activity for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of The Doctors Company and California State University Institute for Palliative Care. The Doctors Company is accredited by the ACCME to provide continuing medical education for physicians.
Call to buy the entire series: 760-750-7288.
Developing Partnerships with Payers consists of four separate modules each focused on a critical aspect of payer relationships.
By the end of this course participants will be able to:
Module 1: Health plan incentives for community-based palliative care
- Identify reasons why health plans are investing in the development of community-based palliative care programs
- Describe the changing policy landscape for health plans following the Affordable Care Act implementation and how that creates a business case for community-based palliative care
- Identify measures important to commercial, Medicare Advantage, and Medicaid health plans
Module 2: Leveraging value-based healthcare in negotiations with health plans
- Identify the types of reimbursement structures health plans have used and how they are evolving from fee-for-service to pay-for-performance
- Describe ways value-based pay mechanisms play a role in transforming care for those who are seriously ill
- Differentiate between the incentive and reimbursement structures allowable under commercial, Medicare, and Medicaid health plans
- Identify how community-based palliative care programs can align and fit under current and future accountable care organization arrangements
Module 3: Creating a business case and proposal for health plans
- Describe ways to identify the subset of the population with whom you’d like to begin a program or pilot with your health plan.
- Identify how to find associated costs and potential savings for those patients you have identified as potential participants in the program.
- Describe the metrics to include in your proposal to a health plan and the value behind them.
Module 4: Reimbursement models
- Describe the different types of reimbursement models most often used by health plans when working with providers.
- Select the reimbursement model most appropriate for your program or project.
- Apply your chosen reimbursement model in a business case within the proposal to your health plan.
Torrie Fields, MPH
Torrie leads the development and implementation of programs and processes at Blue Shield of California and Care1st Health Plan that work to improve the quality of life for individuals with serious or life limiting illness and their families.
Torrie has most recently worked as the program director for palliative care at Cambia Health Solutions and as a consultant for health plans, purchasers, and educational institutions to assist them in understanding the impact of palliative care on the medical system. Torrie led the development of highly successful palliative care initiatives including benefit design, case management, caregiver support, medical home development, and policy and engagement efforts.
DATE: Register Anytime
CONTINUING EDUCATION HOURS: 5 hours, CA BRN and BBS approved provider OR Click HERE for CME Credit Info*
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This is just one of 11 courses in the Building a Community-Based Palliative Care Program series designed to help you build a sustainable palliative care program. Navigate below to see related courses in the series.