1. 1 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 © 2014 Cambia Health Solutions, Inc.

2. 2 2 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.” © 2014 Cambia Health Solutions, Inc.

3. 3 3 What is Palliative Care? © 2014 Cambia Health Solutions, Inc. 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

4. 4 4 Examples of Palliative Care © 2014 Cambia Health Solutions, Inc.

5. 5 5 Cambia offers a comprehensive palliative care program by providing services not covered by traditional palliative care programs. 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. Opportunity to Sustain & Improve Quality 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 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

6. 6 6 Medical team conference-direct face to face Care Plan Oversight with Patient and/or Family Specialized care management Advance Care Planning Home Visits for Assistance with Daily Living and Personal Care Caregiver Support Removal of homebound requirement Home Visits for Individual/Family/Marriage Counseling Clinical Social Worker Visits Caregiver Support Care Coordination Home Health Behavioral Health Benefit Expansion PT/OT/ST/CAM Pre-authorization removal Concurrent curative and palliative treatment Medical/ Curative

7. 7 7 Team Medical Social Worker Nurse Specialized Care Management © Cambia Health Solutions, Inc.

8. 8 8 Research Research partnership * Focusing on improvements to be made in the field of oncology Quality Networks * Home health quality review of contracted agencies *Hospice quality review of contracted agencies *SNF quality review of contracted agencies Pilots Primary Care * Serious Illness Medical Home Pilot * Contracting pilot Specialty * Oncology Intervention Pilot * Advance Care Planning Pilot * Specialty/Oncology Multi- Payer Pilot Home Health * Home Health Contracting pilot Training & Development Curriculum * Non-Palliative Care Providers * Palliative Care Providers * Pediatric Train-the-Trainer * Rural Hospice Delivery *Provider Learning Network * Identify Centers of Excellence * Deliver CME training Contracting & Benefit Expansion Contracts * Augmenting contracts based on performance * Enhanced reimbursement for CME training Benefit Expansion * Consider expanding benefits based on findings and based on what is working © Cambia Health Solutions, Inc. Provider Partnerships

9. 9 9 Member, Employer, Community Engagement © 2014 Cambia Health Solutions, Inc. Community Engagement 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

10. 10 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! © 2014 Cambia Health Solutions, Inc.

11. 11 Example of Care Design: Palliative Care at Home for the Chronically Ill Markedly Reduces Overall Utilization 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) © 2014 Cambia Health Solutions, Inc.

12. 12 State of the State Hospital TypeWA StateWest RegionNational For-profit50% (2/4)0% (0/2)26% (108/419) Public63% (5/8)0% (0/1)54% (192/356) Sole Community Provider 67% (2/3)40% (2/5)37% (151/406) 300 or more beds90% (9/10)100% (1/1)85% (597/699) 50 or more beds83% (33/40)29% (2/7)63% (1568/2489) Less than 50 beds29% (8/28)29% (2/7)22% (326/1500) © 2014 Cambia Health Solutions, Inc. 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)

13. 13 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 © 2014 Cambia Health Solutions, Inc. Download for free at: http://www.iom.edu/Reports/2014/Dying-In-America- Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of- Life.aspxhttp://www.iom.edu/Reports/2014/Dying-In-America- Improving-Quality-and-Honoring-Individual-Preferences-Near-the-End-of- Life.aspx Published September, 2014506 pages

14. 14 EOL Resources Honoring Choices NW http://www.honoringchoicespnw.org/http://www.honoringchoicespnw.org/ The Robert Bree Collaborative End-of-Life Report http://www.breecollaborative.org/topic-areas/eol/ 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 http://www.wsma.org/wcm/Patients/Washington_End_of_Life_ Consensus_Coalition.aspx Washington POLST https://www.wsma.org/wcm/Patients/POLST.aspx https://www.wsma.org/wcm/Patients/POLST.aspx Cambia Palliative Care Center of Excellence at UW http://depts.washington.edu/pallcntr/ http://depts.washington.edu/pallcntr/ Center to Advance Palliative Care (CAPC) http://www.capc.org/http://www.capc.org/ American Academy of Hospice and Palliative Medicine (AAHPM) http://aahpm.org/http://aahpm.org/ © 2014 Cambia Health Solutions, Inc.

15. 15 © 2014 Cambia Health Solutions, Inc. The End