Cambia’s Peggy Maguire: Palliative Care Supports Economic Sustainability

Peggy Maguire, president of Cambia Health Foundation, oversees the philanthropic arm of Portland, Ore.-based Cambia Health Solutions, an enterprise that includes more than 20 companies with the mission to improve the economic sustainability of the health care system.

During her tenure, Maguire helped transform the foundation from a regional grant-making institution to an investor in programs to advance palliative care leadership, quality, access and awareness. The foundation’s signature program, called Sojourns, selects 12 emerging palliative care leaders to receive two-year $180,000 grants to fund projects to further palliative care innovation.

In addition to her work with the foundation, Maguire also leads Cambia’s corporate social responsibility, ethics, compliance and palliative care solutions operations nationwide and advises the parent company and its subsidiaries on strategic investments.

Maguire recently sat down with Hospice News at the End Well conference in San Francisco to discuss Cambia’s work to advance palliative care in the United States as well as investment trends in the hospice space.

Cambia is a multi-faceted organization. Can you introduce the company and its components?

Cambia is a total health solutions company that is founded on three different platforms. We have a health insurance business; that’s our legacy business. It’s more than 100 years old, and we operate Blue Cross Blue Shield plans in Oregon, Washington, Idaho and Utah.

The second major platform of our company is the Cambia Health Foundation, and it was founded in 2007. Our interest in palliative care and caregiving solutions really grew out of our work in the foundation. We really learned a lot through the foundation, and now we’re building those lessons into the other parts of our company.

The third platform is called Echo Health Ventures, and it is a joint partnership between Cambia and Blue Cross Blue Shield of North Carolina that is really looking to invest in resources that make health care better for people and for families.

All of the pillars and all the companies within the Cambia family are in service to a common purpose, which is to help make health care more person-focused and economically sustainable. We really want to change the way people experience the health care system and make the journey more about the unique needs of people and families and less about the institutions of health care.

Part of your role at Cambia is to advise the company on strategic investments. There has been a number of private equity investors moving into the hospice and palliative care space. What do you see as the drivers contributing to that trend?

I think what’s driving venture money here is that people see that there’s a problem, that the health care system isn’t working as well as it could. About 70% of people say they want to die at home, yet 70% die In the hospital, I think that people want to find solutions to solve consumer problems to address that pain point.

Have you perceived any particular trends in terms of where investors are putting their money in the hospice and palliative care space?

I think people are trying to figure out how to provide care in the home.

For example, there’s a company that we invested in through Echo Health Ventures called Dispatch Health, that brings urgent care services into the home. So say, your kid falls in the driveway and scrapes their knee or scrapes their chin and needs stitches. Instead of taking them to an urgent care center, you can call Dispatch Health and they would send clinicians to you.

I see similar trends happening in the investor space that’s really trying to figure out how you support community- and home-based palliative care.

You have been described as the architect for Cambia’s comprehensive approach to serious illness. Can you describe that approach?

We do have a comprehensive approach to palliative care and caregiving support. It started with our corporate philanthropy and the foundation. When we set up the foundation, we wanted to pick an area of health care that was underfunded — but that was consistent with our cause of making health care more person-focused and economically sustainable. We chose palliative care, because it really does change the experience of people living with serious illness and their caregivers.

Part of being a good architect is listening to what people need and then trying to design solutions around what they’re telling you. We learned so much from the people that we met in the palliative care community, the grantees that we funded, and it presented us with just really amazing opportunities and amazing work.

We asked ourselves: We’re out there advocating for palliative care and serious illness care — how do our own health plan members experience that? So we looked at our health plan benefits and the services that were available, and we decided they were not sufficient. We needed to expand them. This was back in 2014.

We began to expand our health plan benefits. We really liberalized the hospice benefit by taking away the requirement that you had to have a doctor certify that you had six months to live. We expanded home health visits and removed some preauthorization requirements. We also made it available along with curative care, and then we made it available across all lines of business without additional premiums.

We began paying for advanced care planning conversations before it became a Medicare benefit, and we provided personalized case management support from palliative care-trained nurses. We call that our Personalized Care Support program, and we have specialized case management staff that work with our members who have serious illnesses and also provide support to their caregivers.

We also decided to cover family and marriage counseling in the home, because we know the stress on the relationships and on the caregivers is very significant. We were one of the first health plans in the country to support caregivers in that way, if not the very first.

For our own employees, we created a resource group called the Caregiver Palliative Care Employee Resource Group. This is a peer-to-peer counseling platform for our 5,000 Cambia employees where people come together on a monthly basis to share their own personal stories and experiences about caregiving or living with a serious illness. We also bring in outside speakers to talk to them and to support their needs.

How did that expansion of palliative care without raising premiums impact your business?

We don’t track these data, but there is a thought that if people have more control and more say in their care, if they know what their options are, and if they’re offered palliative care sooner in the trajectory of their disease, that it will allow them to live well and live longer without suffering through unwanted and unnecessary care. Eventually, the supposition is that this will result in cost savings.

Our CEO, Mark Ganz, coined the phrase that what we are doing is not about a return on investment — it’s about a return on humanity. He really believes that what we’re doing is the right thing to do, that it’s the right thing morally and ethically to support people with serious illness and their family members in this way.

When we introduced the expanded benefits back in 2014, He said that we were not going to look at this as a straight up actuarial problem. That’s not the issue. The issue is how do people experience the health care system and what we can do to improve that experience.

Like any health insurance company, we experienced financial headwinds, but I don’t think that will cause us ever to change this benefit. I’m not suggesting that we’re not shrewd business people, but we do have a philosophical approach to changing the health care experience.

How do you go about identifying patients that might be in need of palliative care?

We do this in a number of ways. One, we allow patients to self identify. They can call us or their caregivers can call us. Of course, we accept physician referrals from clinicians in our network. We also have a partnership with a company called GNS Healthcare that uses predictive analytics to identify members of our Medicare Advantage population that could benefit from an extra layer of support.

None of these methods are perfect. The problem with waiting for referrals is they often come very late, even physician referrals. I believe people can benefit from palliative care as soon as they’re diagnosed with a serious illness, but the culture of the health care system hasn’t gotten there yet, and we’re working on that.