Healthcare Business News

Palliative-care medical home pilot starting in West

By Steven Ross Johnson
Posted: June 20, 2014 - 4:00 pm ET

Increasing the role of palliative care within the framework of acute-care treatment is the goal behind a new program being launched by regional insurer Cambia Health Solutions, company leaders said Thursday.

The new initiative is set to begin July 1, and will be offered to the more than 2 million members covered within the six health plans the company operates across Oregon, Washington, Idaho and Utah.

As part of the program, Cambia will begin paying for such services as counseling for advance care planning, and care coordination and medical team conferences among heath providers for seriously ill patients. In addition, the insurer will provide reimbursement for home health aides, and in-home counseling, and provide training to providers on developing their ability to better engage patients and their families on discussing a plan for end-of-life care.

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“We are embarking on designing a serious illness or palliative-care medical home pilot where we can support providers and members in delivering the care that the members need in their homes or in an outpatient setting,” said Torrie Fields, program director for serious illness and palliative care at Cambia.

The goal, according to Field, is to financially support providers to begin having conversations with patients earlier in the illness process about their quality-of-life plans. Doing so would help toward changing the perception of palliative care as something to consider during a patient's final few months, when the goal of treating an illness is abandoned, according to Mark Ganz, Cambia president and CEO.

“Palliative care is something that should be engaged immediately upon someone being diagnosed or suffering an injury that's potentially life-threatening but not necessarily terminal,” Ganz said. “If we engage palliative care early enough, then actually patient outcomes are far better.”

Around 5% of patients accounted for an estimated 60% of healthcare costs in 2011, according to the Center to Advance Palliative Care, a national organization that provides information on palliative-care programs for healthcare professionals. Among those patients, 49% are those who had serious, severe acute-care needs for a period of one year or less, while patients who were in the last year of their life made up roughly 11%.

As most healthcare providers and payers focus on providing care that offers the best value and health outcomes, palliative care has gained more attention in recent years as a potential way to reduce hospital utilization and visits to the emergency room for seriously ill, medically complex patients. The demand for alternatives is only expected to increase in the coming years as the nation's elderly population grows and the prevalence of chronic disease continues to rise.

“We're sort of at this tipping point where lots of people in the health system are looking at how to solve this problem, and palliative care as sort of the solution,” said Emily Warner, senior policy analyst at the Center to Advance Palliative Care.

But Ganz vehemently denied the idea that financial savings were in any way a motivating factor toward the development of Cambia's program, saying the goal is to provide a more personalized approach to care for patients and their families.

“I think there's a tremendous opportunity here to make a huge amount of progress in the way patients are treated,” Ganz said.

Follow Steven Ross Johnson on Twitter: @MHsjohnson

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