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The New World of Palliative Care

2015 State of ReformWashington Health Policy Conference

Bruce Smith, MD, FACP

Executive Medical Director, Regence BlueShield

January 8, 2015

© 2014 Cambia Health Solutions, Inc.

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Who is Cambia?

•Nonprofit total health solutions company•Health plans: Regence, Asuris, Bridgespan•22 other companies•Affiliated Cambia Health Foundation•Overarching Cause:

“Serve as a catalyst to transform healthcare, creating a person-focused and economically

sustainable health system.”

© 2014 Cambia Health Solutions, Inc.

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What is Palliative Care?

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Specialized medical care for people with serious illness. Appropriate for any age, for any diagnosis, at any stage of a serious illness, and provided along with curative or life-prolonging treatment.

Focused on providing patients relief from the symptoms, pain and stress of a serious illness – whatever the diagnosis.

Intended to improve the quality of life for the patient and the family. Provided by an interdisciplinary team of doctors, nurses, ancillary

providers and others working together to provide an extra layer of support.

CAPC, 2011

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Examples of Palliative Care

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Cambia offers a comprehensive palliative care program by providing services not covered by traditional palliative care programs.

Our goal is to ensure our members’ desires/wishes are documented and honored.

• Medical/Curative• Behavioral Health• Home Health• Psychosocial

Today, palliative care services are not comprehensive; and fragmented at best.

Opportunity to Sustain & Improve Quality

What makes Personalized Care Support special?Cause-drivenComprehensive, patient and family centered carePalliative care beginning at diagnosis and ending after deathDedicated care managersCaregiver supportReimbursement on quality metrics

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Medical team conference-direct face to face Care Plan Oversight with Patient and/or Family Specialized care management Advance Care Planning

Home Visits for Assistance with Daily Living and Personal Care

Caregiver Support Removal of homebound requirement

Home Visits for Individual/Family/Marriage Counseling

Clinical Social Worker Visits Caregiver Support

Care Coordination

Home Health

Behavioral Health

Benefit Expansion

PT/OT/ST/CAM Pre-authorization removal Concurrent curative and palliative treatment

Medical/Curative

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Team• Medical Social

Worker• Nurse

Specialized Care Management

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Research

Research partnership* Focusing on improvements to be made in the field of oncology

Quality Networks * Home health quality review of contracted agencies

*Hospice quality review of contracted agencies

*SNF quality review of contracted agencies

Pilots

Primary Care* Serious Illness Medical Home Pilot

* Contracting pilot

Specialty* Oncology Intervention Pilot

* Advance Care Planning Pilot

* Specialty/Oncology Multi-Payer Pilot

Home Health * Home Health Contracting pilot

Training & Development

Curriculum * Non-Palliative Care Providers

* Palliative Care Providers

* Pediatric Train-the-Trainer

* Rural Hospice

Delivery *Provider Learning Network

* Identify Centers of Excellence

* Deliver CME training

Contracting & Benefit ExpansionContracts* Augmenting contracts based on performance

* Enhanced reimbursement for CME training

Benefit Expansion* Consider expanding benefits based on findings and based on what is working

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Provider Partnerships

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Member, Employer, Community Engagement

© 2014 Cambia Health Solutions, Inc.

Community Engagement• Use messaging to uncouple palliative care and end of life care• Develop a media campaign • Partnerships with state and local community organizations• Development and sponsorship of awareness events

Government Affairs• Engage in state and federal policy discussion• Coalition development and participation• Community advocacy efforts on National Healthcare Decisions

Day

Employee Wellness• Employee workshops on The Conversation Project• Add advance care planning to WellPower Scorecard

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Measuring What Matters: Success

•Achievement of the Triple AimPatient and family experienceImproved qualityAppropriate site of service

•Upstream identification•Stigma reduction• Improved communication•Honoring patient choice

Which means it first must be documented!

© 2014 Cambia Health Solutions, Inc.

1111 © 2014 Cambia Health Solutions, Inc.

Example of Care Design: Palliative Care at Home for the Chronically Ill Markedly Reduces Overall Utilization

• Service Use Among Patients Who Died from Heart Failure, Chronic Obstructive Pulmonary Disease, or Cancer While Enrolled in a Palliative Care Intervention or Receiving Usual Care, 1999–2000; (Brumley, R.D. et al. JAGS 2007)

13.211.1

2.3

9.4

4.6

35.0

5.3

0.92.4

0.90

10

20

30

40

Home healthvisits

Physicianoffice visits

ER visits Hospital days SNF days

Usual Medicare home care Palliative care intervention

13.211.1

2.3

9.4

4.6

35.0

5.3

0.92.4

0.90

10

20

30

40

Home healthvisits

Physicianoffice visits

ER visits Hospital days SNF days

Usual Medicare home care Palliative care intervention

1212 © 2014 Cambia Health Solutions, Inc.

State of the State

Hospital Type WA State West Region National

For-profit 50% (2/4) 0% (0/2) 26% (108/419)Public 63% (5/8) 0% (0/1) 54% (192/356)

Sole Community Provider

67% (2/3) 40% (2/5) 37% (151/406)

300 or more beds 90% (9/10) 100% (1/1) 85% (597/699)50 or more beds 83% (33/40) 29% (2/7) 63% (1568/2489)Less than 50 beds 29% (8/28) 29% (2/7) 22% (326/1500)

Hospitals with Palliative Care

Washington State received an “A” grade for availability of hospital-based palliative care services in 2012.

From The Center to Advance Palliative Care (CAPC.org)

1313 © 2014 Cambia Health Solutions, Inc.

The Institute of Medicine Report

Dying in America

Improving Quality and Honoring Individual Preferences Near the End of Life

Committee on Approaching Death: Addressing Key End-of-Life Issues

Download for free at: http://www.iom.edu/Reports/2014/Dying-In-America-Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of-Life.aspx

Published September, 2014 506 pages

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EOL Resources• Honoring Choices NW http://www.honoringchoicespnw.org/

• The Robert Bree Collaborative End-of-Life Report http://www.breecollaborative.org/topic-areas/eol/

• Washington End-of-Life Coalition http://www.wsma.org/wcm/Patients/Washington_End_of_Life_Consensus_Coalition.aspx

• Washington POLST https://www.wsma.org/wcm/Patients/POLST.aspx

• Cambia Palliative Care Center of Excellence at UW http://depts.washington.edu/pallcntr/

• Center to Advance Palliative Care (CAPC) http://www.capc.org/

• American Academy of Hospice and Palliative Medicine (AAHPM) http://aahpm.org/

1515 © 2014 Cambia Health Solutions, Inc.

The End