Insurer Cambia Health Solutions set a goal last year to change the model of palliative care delivery. To accomplish it, the West Coast company is soliciting the help of innovators and entrepreneurs from the tech world.
CEO Mark Ganz was on hand at Health 2.0 in Santa Clara, Calif., in October talking about palliative care during a panel session on sensitive challenges. The four-day event allows innovators to demo new technology and link up with investors.
Afterward, Ganz said the Portland, Ore.-based company is looking for entrepreneurs “who want to take it to the streets”—people who will design the apps and digital tools that will help patients make end-of-life care choices or receive palliative care at home, if they so desire.
Palliative care has long been part of the not-for-profit company's mission and is one of the three areas of focus for its foundation, which has awarded more than $20 million in grants over the past 10 years.
But about two years ago, Ganz sent the charge to Cambia's health plans to write new benefits for palliative care, said Dr. Bruce Smith, who was named executive medical director for the personalized care support program in August.
Those benefits now include support for caregivers of terminally ill members even if the caregivers aren't members themselves. “It turns out that having a good caregiver is really important and also really taxing to the caregiver,” Smith said. “By providing a benefit for caregivers, employers are actually very interested in that.”
The insurer also has been paying for discussions around end-of-life care since November 2014 and is hoping the CMS will follow suit in January.
The mission is personal for Ganz, who described watching doctors and nurses ignore his mother's “do not resuscitate” order on the night that she died. “I look at palliative care, and the gap that exists today is a microcosm of the larger healthcare system,” he said in Santa Clara. “It reflects a culture in healthcare that's very much locked into the economic model.”
Under fee-for-service, hospitals are compensated for how much care they provide to patients, which encourages them to invest in intensive care rather than palliative care, he said.
Cambia supports research and education around palliative care though the Cambia Palliative Care Center of Excellence at the University of Washington, which was renamed last December after the company established a $10 million endowment.
But patients and their caregivers also need the right tools to carry out end-of-life wishes. And that's where its technology investments come in.
Technology will allow patients to stay in and receive care in their homes, which is where most people say they'd prefer to be. It also can connect doctors and patients with new communication devices. “Those are the kinds of things we want to invest in,” Smith said.
One of the programs that the Cambia Foundation has funded is the Conversation Project, an organization that encourages people to talk about their end-of-life wishes with their loved ones. Journalist Ellen Goodman co-founded the group in 2010 after having to make end-of-life decisions for her own mother.
The Conversation Project has a two-prong strategy: a robust media and public awareness campaign and providing people with the tools to have their own conversations. About 250,000 people have downloaded the Conversation Starter Kit from the group's website, and the organization estimates it has been shared more than 1 million times.
“It's really neighbor-to-neighbor, friend-to-friend,” said Harriet Warshaw, executive director of the Conversation Project. “This is nothing that can be imposed.”
Cambia was one of the first organizations to extend advanced care planning to its own employees, Warshaw added. “They have been remarkable and they did it at a time when it wasn't as politically correct to do it,” she said.
Technology also has helped bring more attention to and normalize end-of-life issues, both Smith and Warshaw noted. Brittany Maynard, a 29-year-old battling brain cancer, used social media to become an advocate for so-called death-with-dignity laws after choosing to end her own life. And the popular book and film "The Fault In Our Stars" helped break down the stigma around the topic of death and dying.
“There's been a lot of cultural change,” Warshaw said, “and it's because the seeds have been planted.”