Transcript Bruce Smith, Medical Director, Regence BlueShield

The New World of Palliative Care
2015 State of Reform
Washington Health Policy Conference
Bruce Smith, MD, FACP
Executive Medical Director, Regence BlueShield
January 8, 2015
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© 2014 Cambia Health Solutions, Inc.
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.”
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© 2014 Cambia Health Solutions, Inc.
What is Palliative Care?
 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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Opportunity to Sustain & Improve Quality
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.
Cambia offers a
comprehensive palliative
care program by providing
services not covered by
traditional palliative care
programs.
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
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Benefit Expansion
Care Coordination
Home Health
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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
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Home Visits for Assistance with Daily Living and
Personal Care
Caregiver Support
Removal of homebound requirement
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Behavioral Health
Medical/
Curative
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Home Visits for Individual/Family/Marriage
Counseling
Clinical Social Worker Visits
Caregiver Support
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PT/OT/ST/CAM Pre-authorization removal
Concurrent curative and palliative treatment
Specialized Care Management
Team
• Medical Social
Worker
• Nurse
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Provider Partnerships
Research
Pilots
Research partnership
Primary Care
* Focusing on improvements to * Serious Illness Medical Home
be made in the field of
Pilot
oncology
* Contracting pilot
Training &
Development
Quality Networks
* Home health quality review of Specialty
contracted agencies
* Oncology Intervention Pilot
*Hospice quality review of
* Advance Care Planning Pilot
contracted agencies
* Specialty/Oncology MultiPayer Pilot
*SNF quality review of
contracted agencies
Curriculum
* Non-Palliative Care Providers
* Palliative Care Providers
* Pediatric Train-the-Trainer
* Rural Hospice
Contracting &
Benefit
Expansion
Contracts
* Augmenting contracts based
on performance
* Enhanced reimbursement for
CME training
Home Health
* Home Health Contracting
pilot
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Delivery
Benefit Expansion
*Provider Learning Network
* Consider expanding benefits
* Identify Centers of Excellence based on findings and based
on what is working
* Deliver CME training
© Cambia Health Solutions, Inc.
Member, Employer, Community Engagement
Community Engagement
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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 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!
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Example of Care Design: Palliative Care at Home for
the Chronically Ill Markedly Reduces Overall Utilization
Usual Medicare home care
Palliative care intervention
40
35.0
30
20
13.2
11.1
9.4
10
5.3
2.3
0.9
2.4
4.6
0.9
0
Home health
visits
Physician
office visits
ER visits
Hospital days
SNF days
• 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)
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State of the State
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)
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Hospital Type
WA State
West Region
National
For-profit
Public
Sole Community
Provider
300 or more beds
50 or more beds
Less than 50 beds
50% (2/4)
63% (5/8)
0% (0/2)
0% (0/1)
26% (108/419)
54% (192/356)
67% (2/3)
40% (2/5)
37% (151/406)
90% (9/10)
83% (33/40)
29% (8/28)
100% (1/1)
29% (2/7)
29% (2/7)
85% (597/699)
63% (1568/2489)
22% (326/1500)
© 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
Published September, 2014
506 pages
Download for free at: http://www.iom.edu/Reports/2014/Dying-In-AmericaImproving-Quality-and-Honoring-Individual-Preferences-Near-the-End-ofLife.aspx
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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/
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The End
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