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Important Resources.
Learn more about your contract with Alignd.Palliative, and how to make the most of the partnership with information and resources here, including your contract with us, and payment models.
This guide provides a comprehensive implementation handbook for doctors and multi-disciplinary palliative teams (MDTs) to ensure a good understanding of the Alignd.Palliative benefit, to select the best option for your practice as an entry point, as well as to ensure an efficient claims submission process for services rendered by Palprac doctors and the MDTs.
Download the Doctor Manual here
The Network agreement between Alignd and yourself, as a palliative care trained practitioner and a full member of Palprac is the contract that you need to sign to join the Alignd network.
Download the Alignd.Palliative Network Agreement here
The fees payable by the schemes to the AP Network Doctors are dependent on the phase of the AP Benefit on which a particular patient is enrolled. Fees for services (FFS) rendered to patients enrolled on the Initial Benefit and the Ongoing Benefit is on a FFS basis.
For members on the Intensive Benefit during a transition period, payments made will be on a FFS basis. Following the transition period, for members on the Intensive Benefit payments made to Clinical Alliance will be on the basis of a tiered global professional fee (GPF) based on the performance outcomes of the Clinical Alliance in the previous year.
You can find more detail in the Doctor Manual
The billing schedule sets out the specific services and benefit limits included in Alignd.Palliative. In order to access the benefit, unique (so called “dummy”) Alignd Tariff Codes need to be used. The exact codes and related rates will vary between different Schemes and administrators. Appendix 2 in the Doctor Manual details those rates applicable to Medscheme Holdings.
Alignd will assist the AP Network Providers to ensure correct billing is used. The Remote GP will have codes and recommended rates applicable to those patients on the Remote Access Benefit.
- Billing for the Clinical Alliance
- Owing to HPCSA regulations, the Global Professional Fee cannot be paid to an individual AP Network Doctor using their practice number, but only to Clinical Alliance.
- Alignd is currently developing an in-house solution to assist AP Network Doctors with incorporating an Clinical Alliance. Part of the legal requirements imposed on the Clinical Alliance will be to contract with each individual HCP within the Clinical Alliance, with an agreed payment rate payable to each HCP based on a jointly agreed percentage of the Global Professional Fee, per month.
The fees will be revised annually by Alignd, in consultation with the Alignd.Palliative Network Provider and the schemes, with any changes to be communicated to the AP Network Providers by not later than the end of October of any year in respect of fees payable during the following calendar year.
Download the billing schedule here
Signapps is a patient-centric, POPI-compliant digital communication tool to assist multi-disciplinary teams with optimal care delivery and care-coordination. It can integrate with any electronic medical record system.
All palliative care doctors and palliative multi-disciplinary teams will need to use Signapps when managing Alignd patients. A channel will be created for each patient at the time of enrolment. The use of Signapps facilitates communication between the care team, and between the team and Alignd. It enables Alignd to have a view of team interactions in a non-invasive manner. These interactions will inform the care co-ordination metric in the outcomes-based payment.
The cost of all Signapps patient threads for Alignd patients will be covered by Alignd.
Download the easy-to-follow Signapps training info here and you can get in touch for further assistance by contacting Signapps support@getsignapps.com or your Alignd Care Partner.
The Alignd.Palliative benefit covers palliative medicines and consumables found in the AP medicines formulary and consumables list under the Intensive Benefit only. The Alignd.Palliative medicines formulary consists of a comprehensive list of evidence-based drugs required to ensure optimal symptomatic management for patients with advanced stage or metastatic cancer. It includes several formulations including tablets, syrups, suppositories and injectables. The consumables list includes various palliative consumables, such as urinary catheter bags and nebuliser masks. The medicines formulary and consumables list will be reviewed on a quarterly basis and Alignd will provide updates accordingly.
Download medicines formulary and consumables list here
When you want to enrol a patient on the AP Benefit, you can email Alignd at referrals@alignd.co.za. We will ask you to complete an enrolment form, which will provide us with all relevant patient details necessary for Alignd to receive authorisation for the Alignd.Palliative benefit from the scheme.
Download the enrolment form here
For health care providers, integrating advance care planning into routine clinical encounters enables them to help patients and families to prepare for the kinds of decisions they may face in future. These conversations explore the patient’s wishes and goals for treatment framed within the therapeutic options that are appropriate for their condition.
Conversations are best started early in the patient’s course of care and treatment and whenever clinically relevant to the patient’s care.
Download an advance care plan template here
How will I know which of my patients are eligible for Alignd’s Palliative Care Benefit (APCB)?
Any patient that meets the clinical criteria set out in the Doctor Manual and is enrolled with a medical scheme that offers the Alignd.Palliative benefit is eligible for the AP benefit.
As more schemes offer cover to their members for AP benefit, we will alert you via e-mail. There will also be a updated list of participating schemes.
What will the patient journey with Alignd look like?
A patient will get referred to Alignd, and will be offered the Alignd benefit if the clinical criteria are met. The patient will need to accept the Alignd benefit, and then he or she will be matched with an Alignd Network Doctor. The doctor has two days to accept the patient offer.
The first face-to-face palliative care assessment will take place with the patient, and the doctor will load the patient onto Signapps. The patient will move to either the Ongoing or Intensive Benefit. The MDT will care for the patient, who may move to the Intensive Benefit when the clinical criteria met.
Who will decide on whether a patient meets the clinical entry criteria for Alignd.Palliative Care Benefit?
There are specific clinical entry criteria for eligibility; cessation of curative treatment is a not requirement for the APCB. You can find more detail on this in Doctor Manual. Should there be a dispute with regard to eligibility, there is a robust appeals process in place for both network doctors and scheme members.
Is the Alignd.Palliative (AP) benefit only for oncology patients?
Yes. The AP benefit is currently only available for patients with metastatic cancer, who require palliative care.
Are there any restrictions as to the geographical area that our multi-disciplinary team (MDT) can offer services?
Our benefit is designed to ensure little to no micromanagement of the clinical teams on the ground. As such there are no restrictions on areas of service. The only requirement around this is for a network doctor to service at least a 10km radius.
Our Remote Access Benefit will rely heavily on existing community-based services due to the paucity of palliative care services available in more remote areas. If there is an area with a relative oversupply of Palprac teams, then the enrolled patient and their family will be given a choice of which team to assist them. If they express no preference, a rota system will be used.
Who do I bill to?
Our AP network doctors will need to bill the relevant medical scheme, using the Alignd tariff codes.
How do I create a Clinical Alliance to bill for the services of our MDT as a global professional fee covered in the Intensive Benefit?
According to HPCSA, the global professional fee cannot be paid to an individual doctor; it must be paid to an MDT legal entity of its own, which means you need to set up an MDT legal entity to be able to receive the GPF on behalf of the MDT.
We are in the process of developing a seamless solution. Once this is in place we will communicate it to all AP network doctors. For the time being, our AP network doctors can bill using our FFS transition period tariff codes under the Intensive benefit.
Hospices can form their own MDT if the Alignd.Palliative Network Doctor is employed by the hospice. Social workers and nurses employed by hospices can also form part of independent MDTs.
How will I know how to split the daily global professional fee to pay the individual healthcare professionals in the MDT?
We are developing a calculator to assist you with this and once the user interface is ready, we will share it with all Alignd.Palliative network doctors.
How can I refer a patient to the Alignd.Palliative benefit?
You can simply email us at referrals@alignd.co.za
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