Insurer Begins Huge Palliative Care Program

“Person-centered care” is the buzz phrase  floating around the health care industry, and a Pacific Northwest-based giant insurer thinks it has hit the mark with a new palliative care program coming this summer.

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Cambia Health Solutions, which includes Regence Blue Cross Blue Shield,will offer training to providers and additional benefits for policyholders: more than 2.2 million members in Cambia’s family of health plan companies in Oregon, Washington, Idaho and Utah.

Palliative care improves the quality of life by managing pain and other problems for people who have serious life-threatening medical conditions, such as cancer, heart and kidney failure. It differs from hospice care, especially because patients do not necessarily have less than six months to live.

Mark Ganz, president and CEO of Cambia, said the company realized providers are focused on disease treatment but they “never stop to ask the patient and family ‘How do you want to live with this?'”

“Palliative care at its best is in partnership with curative care,” Ganz said. “It’s not after curative care when it no longer matters or no longer is working.”

The company is going to start paying for things not typically reimbursed by other insurance companies including home health aides and advanced care planning counseling. One of the larger initiatives is training physicians and caregivers in how to have appropriate conversations about end-of-life care.

Dr. Csaba Mera, chief medical officer at Cambia Health,  said the goal is to develop a holistic, comprehensive integrated program: “It’s about making sure (the patient’s) wishes are clearly documented, they’re respected and that they’re implemented so it’s not a crisis if they do at some point end up in terminal care and decisions have to be made,” Mera said.

Dr. J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, a Virginia-based nonprofit organization representing hospice and palliative care programs, said Cambia’s program could become a national model as more and more providers look to integrate palliative care into their facilities. He said the the education and training component of the program is particularly critical.

“We’re an aging population with the baby boomers. More people are going to need to start having these conversations and accessing these services,” Schumacher said. “These are hard conversations to have if you don’t have the training.”

Ganz said over the years insurance companies have taken to following the Centers for Medicare & Medicaid Services’s guidelines in how they look at palliative care and Cambia’s new initiative is fueling “creative tension” in the industry in how to approach it.

“We’re striving to take palliative care to the patient as opposed to forcing the patient to come into rigid walls of institution that tell you how exactly they’re going to treat you,” Ganz said. “Our hope is that the rest of the health care industry will follow suit.”

The company anticipates that the program will be in effect by early next year

This article was produced by Kaiser Health News with support from The SCAN Foundation.