1
2015 State of Reform
Washington Health Policy Conference
Bruce Smith, MD, FACP
Executive Medical Director, Regence BlueShield
January 8, 2015
© 2014 Cambia Health Solutions, Inc.

• 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.

 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
© 2014 Cambia Health Solutions, Inc.

© 2014 Cambia Health Solutions, Inc.

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.
What makes Personalized Care Support special?
 Cause-driven
 Comprehensive, patient and family centered care
 Palliative care beginning at diagnosis and ending after death

Dedicated care managers

Caregiver support
 Reimbursement on quality metrics
Cambia offers a comprehensive palliative care program by providing services not covered by traditional palliative care programs.

Care Coordination
Home Health
Behavioral Health
Medical/
Curative
 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

PT/OT/ST/CAM Pre-authorization removal
 Concurrent curative and palliative treatment

Team
• Medical Social
Worker
• Nurse
© Cambia Health Solutions, Inc.

Research
Pilots
Research partnership
* Focusing on improvements to be made in the field of oncology
Primary Care
* Serious Illness Medical Home
Pilot
* Contracting pilot
Quality Networks
* Home health quality review of contracted agencies
*Hospice quality review of contracted agencies
*SNF quality review of contracted agencies
Specialty
* Oncology Intervention Pilot
* Advance Care Planning Pilot
* Specialty/Oncology Multi-
Payer Pilot
Training &
Development
Curriculum
* Non-Palliative Care Providers
Contracting &
Benefit
Expansion
Contracts
* Palliative Care Providers
* Augmenting contracts based on performance
* Pediatric Train-the-Trainer
* Rural Hospice
* Enhanced reimbursement for
CME training
Home Health
* Home Health Contracting pilot
Delivery
Benefit Expansion
*Provider Learning Network
* Identify Centers of Excellence
* Deliver CME training
* Consider expanding benefits based on findings and based on what is working
© 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
© 2014 Cambia Health Solutions, Inc.

• Achievement of the Triple Aim
 Patient and family experience
 Improved quality
 Appropriate site of service
• Upstream identification
• Stigma reduction
• Improved communication
• Honoring patient choice
 Which means it first must be documented!
© 2014 Cambia Health Solutions, Inc.

Example of Care Design: Palliative Care at Home for the Chronically Ill Markedly Reduces Overall Utilization
Home health visits
Physician office visits
• 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)
© 2014 Cambia Health Solutions, Inc.

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)
Hospital Type WA State
For-profit
Public
50% (2/4)
63% (5/8)
Sole Community
Provider
67% (2/3)
300 or more beds 90% (9/10)
50 or more beds 83% (33/40)
Less than 50 beds 29% (8/28)
West Region
0% (0/2)
0% (0/1)
40% (2/5)
100% (1/1)
29% (2/7)
29% (2/7)
Hospitals with Palliative Care
National
26% (108/419)
54% (192/356)
37% (151/406)
85% (597/699)
63% (1568/2489)
22% (326/1500)
© 2014 Cambia Health Solutions, Inc.

Improving Quality and Honoring Individual Preferences
Near the End of Life
Committee on Approaching Death: Addressing Key End-of-Life
Issues
Published September, 2014 506 pages
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
© 2014 Cambia Health Solutions, Inc.

• 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/
© 2014 Cambia Health Solutions, Inc.

The End
© 2014 Cambia Health Solutions, Inc.