Cambia Health, which owns Regence Blue Cross Blue Shield, is looking to make a statement with its new palliative care program. Aiming to empower consumers' role in their healthcare, the insurance company created a person-focused program that emphasizes patients and their families when care planning for terminal conditions.
To learn more about Cambia's palliative care program, which facilitates members' healthcare needs from wellness through death, FierceHealthPayer spoke with Cambia CEO Mark Ganz (pictured) in an exclusive interview. In part one of a two-part series, Ganz discussed the drivers behind focusing on palliative care and the goals he hopes to attain with the new program.
FierceHealthPayer: Palliative care isn't a topic frequently discussed among insurers. Can you describe why you wanted to focus on this type of care?
Mark Ganz: One of the things that we want to do is take a very bold, cutting-edge position. Our goal is to create tension in the industry that hopefully will cause others to move in our direction. This is not an issue [where] we're motivated by some form of competitive differentiation that we're going to sell more products. It's really to try to move the industry to a more evolved view of the importance and value of palliative care in the treatment of patients. That's how social change happens--you have to have people who will change their positions and others will look at it and say 'I hadn't thought of that before. And that makes a lot of sense.'"
Since we made the announcement, I've had two or three leaders of other companies who have reached out saying they want to talk with me about what we're doing and better understand how we thought about it. And that's exactly what I hoped we would accomplish.
Because this is really an issue about respecting peoples' and their families' wishes, listening to them and ensuring that they have self-determination about how they want to be treated in the midst of advanced or serious illness.
FierceHealthPayer: Can you describe the process that brought you to the decision to announce your coverage of palliative care?
Mark Ganz: About nine years ago, we established the Cambia Health Foundation with a purpose of focusing our philanthropic efforts and aligning them with the cause of our company, which is to serve as a catalyst to transform healthcare by making it more person-focused and economically sustainable. What's important about that cause is that nothing in it suggests or is based on the preservation or glorification of the health insurance part of the business.
The fundamental model and prevailing culture need to change. Right now, you have a model that disengages by its nature the person who is being served from the person who is serving them around the most critical aspect of any engagement, which is value. Patients don't have a good sense of how to measure or evaluate what's a good value for them and what aligns with their personal values. Until we address that flaw, we aren't going to see a change in the system. It will all just be Band-Aids and solutions on the margin.
The conversation is between the relative institutions--whether payers or providers--talking amongst themselves about how things need to change among themselves. And there's been very little conversation about the person we're here to serve--the consumer, the individual, the patient. I've been a very strong voice over the last 11 years--and sometimes a very lonely voice--saying 'wait a minute, stop this.'
We're going to need to build this from the consumer inward. We need to understand how the customers--real people, real families--want to be treated. It's pretty easy for us to imagine that because we're all patients and family members ourselves, so let's start there. And let's build something that doesn't create friction but does create a sense of focus on them and their needs.
FHP: How has the foundation advanced the field of palliative care?
Ganz: We started providing seed money to hospitals all over the Northwest and Intermountain West, because that's where our primary footprint was at the time. We provided money to people within hospitals who cared about this and wanted to build a competency. Our gamble was that if we provided the money and expertise--we contracted with UCSF which has a great palliative care team led by Steve Pantilat, truly a pioneer in this area--so that when we gave a grant to a hospital, Pantilat's team would come in paid for by us to provide the expertise about how to stand one of these things up, make it sustainable and convince the hospital administration that this was valuable and continued to get funded.
The risk we took in making those grants was that the administration, the CEOs of the hospitals wouldn't support it. I'm happy to report that that hasn't been the case. As soon as these programs have been established, they have proven their worth very quickly because of the positive experiences from patients and their families and the feedback they give to hospital administration about how valuable that was to them.
And then the doctors, who didn't know how to do this and knew that they needed to have these conversations but literally were afraid or uncertain how to do it, now have palliative care teams they can bring in to help engage patients early in their treatment, long before they're deemed terminal. These teams come in and work side by side with the curative care that's going on. So it's been a better outcome and the phsycians see the value.
So we've been doing that work for nine years and through grants, now more than $10 million dollars, we've stood up a lot of those programs.
FierceHealthPayer: What are some key takeaways you've learned since launching the foundation's palliative care program?
Mark Ganz: What we found when we started this work eight years ago with the foundation was that there were very few programs in place other than hospice, which is only one small piece of the broader field of palliative care. There were very few hospitals that even had palliative teams or thought it mattered.
And we've done national research with a national journal on this issue. Believe it or not, 98 percent of Americans say they want their doctors to be engaged with them to provide palliative care alongside curative care. And we also surveyed doctors and about 90 percent of doctors want to do this, though many of them don't know how. So there's more opportunity even as we've been doing this work.
FHP: What are the next steps for Cambia's palliative care program?
Ganz: This is the first time that we've moved from the foundation to the health plan world to work on coming up with a cutting-edge, game-changing program in the way we structure the benefits around palliative care, as well as how to engage providers through the financial incentives that comes from paying for this. Our goal is to further the work already being done and really accelerate palliative care.
We've been really careful about going there too soon because, on one hand, you don't want to be in a position of paying for low competence. Just because a health insurer decides to pay for care in a more novel way doesn't guarantee that the actual care provided will be any good. So that's why we started many years ago focusing on the training and competency. Now we feel like it's time to make this next move and do it through the health plan.
But we're not going to let up one bit on the foundation side in terms of advancing the education and competency through direct grants. We're actually creating a program where we mentor certain young people in the industry so they rise in the competency and literally learn how to be stronger leaders in the palliative care field. This is a program we think will further accelerate palliative care by getting to young practitioners who have the desire and capability to be leaders in this field. These are all pieces of the puzzle and we're pretty excited about them.
Editor's Note: This interview has been edited and condensed for clarity.