Strengthen pal­lia­tive care to help build a more pa­tient-cen­tered sys­tem

Modern Healthcare - - COMMENT - By Mark Ganz

It was as a son, not a health­care CEO, that I ex­pe­ri­enced the pain of my mom’s “do not re­sus­ci­tate” or­der be­ing ig­nored. Her med­i­cal team pushed through the door and sub­jected her to a full code, against her wishes, the night her heart beat for the last time.

Not only did we lose my mom that night, my fam­ily and I had to deal with know­ing her wishes weren’t hon­ored at the end of her life.

It was not only that night, but through­out the course of her ill­ness that it felt as if we had to arm wres­tle with providers against un­nec­es­sary tests and pro­ce­dures that would not change the out­come. At times, it was as if the needs of the institution were more im­por­tant than the needs of my mom.

When we’re sick or in­jured, we have con­fi­dence our leg will be fixed or our dis­ease ad­dressed with good cu­ra­tive care. Providers are in tune and trained to treat the phys­i­cal needs of pa­tients.

But un­for­tu­nately, they’re all too of­ten tone-deaf to the art and science of en­gag­ing the spir­i­tual and so­cial needs of the pa­tient and fam­ily. This skill is re­ferred to as pal­lia­tive care.

Pal­lia­tive care re­lies on a deep con­nec­tion be­tween a doc­tor, the pa­tient and the pa­tient’s fam­ily. It’s an un­der­stand­ing that treat­ment isn’t only about a cure, it’s about heal­ing, which to my mom meant an ac­cep­tance and a de­sire for a grace­ful end to her life. When this level of care is ex­plained, with an em­pha­sis on what mat­ters to you in­stead of “What’s the mat­ter with you?” an over­whelm­ing num­ber of peo­ple want it.

In 2011, the Cam­bia Health Foun­da­tion, to­gether with the Na­tional Jour­nal, con­ducted a na­tion­wide sur­vey on Amer­i­cans’ aware­ness and at­ti­tudes to­ward pal­lia­tive care.

We learned two very in­ter­est­ing facts: first, 71% of those sur­veyed were un­fa­mil­iar with the term; and sec­ond, af­ter re­ceiv­ing an ex­pla­na­tion, 97% felt it was im­por­tant for pa­tients and their fam­i­lies to be ed­u­cated about pal­lia­tive care, with end-of-life care op­tions avail­able along with cu­ra­tive treat­ment. When was the last time 97% of Amer­i­cans agreed on any­thing?

This sur­vey sub­stan­ti­ated the work be­gun nearly a decade ago when the foun­da­tion de­cided to lean into this ef­fort. To date, it has in­vested more than $25 mil­lion into pe­di­atric and adult pal­lia­tive-care pro­grams and ini­tia­tives to cre­ate ac­cess and aware­ness and im­prove the qual­ity of pal­lia­tive care. The foun­da­tion’s re­gional col­lab­o­ra­tion in­cludes a $10 mil­lion en­dow­ment to the Univer­sity of Wash­ing­ton in Seat­tle for the Cam­bia Pal­lia­tive Care Cen­ter of Ex­cel­lence, which is quickly be­com­ing a role model for best prac­tices in pal­lia­tive-care ed­u­ca­tion, met­rics and im­ple­men­ta­tion.

A re­cent re­port by the Cen­ter to Ad­vance Pal­lia­tive Care con­firmed the Pa­cific North­west as a leader in the field and we’re hon­ored to play a role. In 2014, we took the lessons from our foun­da­tion work to our re­gional health plans, launch­ing a com­pre­hen­sive pal­lia­tive-care ben­e­fits pack­age. To fur­ther es­tab­lish the ef­fort, we’re fo­cused on fos­ter­ing and in­vest­ing in en­trepreneurs ded­i­cated to trans­form­ing the ex­pe­ri­ence for pa­tients and their fam­i­lies fac- ing a se­ri­ous ill­ness and end of life.

The CMS’ an­nounce­ment in Oc­to­ber that it will be­gin re­im­burs­ing physi­cians for vol­un­tary end-of-life coun­sel­ing with Medi­care pa­tients is a great step for­ward for the in­dus­try. Th­ese dis­cus­sions, co-ex­ist­ing with cu­ra­tive care, can help make the shift to­ward a more holis­tic stan­dard that:

Puts a pa­tient’s phys­i­cal, so­cial and spir­i­tual needs at the cen­ter of his or her care plan

Ex­pands ac­cess to care and rec­og­nizes the role of the fam­ily

En­gages com­mu­ni­ties and pol­i­cy­mak­ers

En­cour­ages in­vest­ment in so­lu­tions and in­no­va­tions

Pal­lia­tive care is a mi­cro­cosm within health­care, in which the needs of pa­tients and their fam­ily mem­bers should be first and fore­most. When I tell my mom’s end-of-life story, I’m con­tin­u­ally amazed by the num­ber of peo­ple who share sim­i­lar sto­ries.

We have an op­por­tu­nity as a health­care sys­tem to meet the grow­ing de­mands of peo­ple and their fam­i­lies to cre­ate a seam­less care ex­pe­ri­ence that puts them at the cen­ter.

The in­dus­try should be thought­ful about that in­tent, un­der­stand­ing that an in­vest­ment in pal­lia­tive care is not about making or saving money. It’s about what fam­i­lies long for, so they feel in con­trol when they’re most vul­ner­a­ble. It’s not a re­turn on in­vest­ment; it’s a re­turn on hu­man­ity, and it’s per­sonal to all of us.

Mark Ganz is pres­i­dent and CEO of Cam­bia Health So­lu­tions and board chair­man of Amer­ica’s Health In­sur­ance Plans.

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