After having launched a palliative care program in 2014, Cambia Health Solutions is now looking for ways to improve patient access to these tools that can improve a patient's quality of life.
There is no arguing that burgeoning healthcare costs are a major concern for the economy, and value-based models are carving out paths to reduce healthcare utilization without compromising on the quality of care for the patient. A review of Medicare payments in the last year of life found that over an 8-year period from 1978 to 2006, Medicare expenditures of beneficiaries in their last year remained nearly steady at over 25%. This is where end-of-life (EOL) discussions would matter. Initiating a conversation on care plans at EOL with patients and their families have been documented to create a fair balance—improving the quality of life for patients during the last few weeks of life and lowering healthcare utilization.
Evidence points to palliative care as an answer to improving the patient quality of care while reducing costs. However, several barriers exist with access to palliative care, including a shortage of trained specialists, insufficient training of care providers, and lack of knowledge or misconceptions among patients and their families as well as care providers. Having realized the advantages of integrating palliative care in mainstream patient care, insurers like Cambia Health Solutions have been proactively working to improve patient access to palliative care.
Cambia’s program, launched over a year ago in July 2014, offers reimbursement for services that include advance care planning, care coordination, and medical team conferences among care providers of seriously ill patients. Additional covered services under the program include reimbursement for home aides, in-home counseling, and provider training to engage patients and their families in EOL care planning.
Mark Ganz, president and CEO of Cambia believes, “If we engage palliative care early enough, then actually patient outcomes are far better.” Ganz has a personal story to narrate, which has fed his passion to promote palliative care. His mother’s care providers ignored her wish of “do not resuscitate” the night she died. Pointing to a healthcare system that is extremely well-adapted to a fee-for-service model that pays more for the amount of care a hospital provides its patients, Ganz says, “It reflects a culture in healthcare that's very much locked into the economic model.”
To expand the reach of palliative care beyond the clinic and to develop tools that can improve patient access to this care service, Cambia is reaching out to technology innovators by participating in meetings like Health 2.0. By developing apps and tools to help patients make EOL choices or receive palliative care in the comfort of their home.
The company’s belief in this process is evident in the fact that Cambia employees are themselves offered the option of advance care planning.