Cambia Health Solutions Lauds Significant Changes to Health Care Coverage

National changes underscore the importance of patient-centered care

October 30, 2015

PORTLAND, Ore. – The Center for Medicare & Medicaid Services (CMS) announced several significant changes in the 2016 Medicare Physician Fee Schedule, indicating a shift in how patients experience healthcare as well as how physicians are compensated for practicing patient-focused care. Cambia Health Solutions, a health solutions company based in Portland, Ore., has publicly recognized two specific elements of the new Physician Fee Schedule as transformative: physician compensation for end-of-life discussions, and a new way to categorize payments for patients with multiple health care providers.

“The decisions we heard from CMS indicate that we’re moving closer to a patient-focused health care system,” said Bruce Smith, MD, FACP, Executive Medical Director for Cambia Health Solutions. “We are proud that Cambia Health Solutions was a part of the CMS conversation. It’s time that we all treat patients as individuals with their own set of needs, goals and beliefs.”

Cambia is a total health solutions company comprised of six regional health plans, 22 direct health-solutions companies, and a corporate foundation that works to accelerate access to palliative care. In 2014, Cambia’s regional health plans in Oregon, Washington, Utah and Idaho introduced a new and comprehensive palliative care initiative called Personalized Care Support. Unlike traditional health care coverage, this program provides holistic support to patients and their caregivers in the event of a serious-illness diagnosis. This can include help addressing pain and symptoms, patient and patient advocate education, mental health counselling and identifying resources in the community. The intent of the palliative care program is to improve quality of life for the patient and their families, loved ones, and caregivers as they navigate a serious illness. 

Also unique to Cambia’s health plans is the fact that physicians are encouraged to discuss goals of care and eventually, end-of-life wishes with their patients. Cambia‘s regional health plans were among the first in the country to reimburse medical providers who take the time to have these important discussions with their patients. Today’s CMS announcement may open doors for other private payers to compensate doctors for these conversations.

Changes to the 2016 Medicare Physician Fee Schedule include:

Separate payment for collaborative care: Many patients see several medical professionals as they face long-term medical conditions as a result of aging or serious illness. The CMS-announced change will establish a care manager who will monitor a treatment plan and coordinate communication between providers.

“Establishing separate payments will incentivize providers to take the time to coordinate health care efforts, provide better management of patients’ pain and symptom relief, and increase communication for an overall improved quality of life,” said Smith.

Physician compensation for end-of-life conversations: Until recently, medical professionals were not paid to engage a patient in conversations about how they want to manage the end of their life. Because there was no reimbursement, the conversation often didn’t happen.

“At Cambia, we made the decision to pay for these conversations when we introduced our palliative care program last year, and we were one of the first to do so. Now that CMS is also going to reimburse, we are hopeful that other private payers will come to understand how important these conversations are. By asking a patient what matters to them as their illness progresses, we can reduce over-treatment at end-of-life, and most importantly, we can respect each patient’s personal wishes,” said Smith.

For more information about the new 2016 Medicare Physician Fee Schedule, click here.

About Cambia Health Solutions

Cambia Health Solutions, headquartered in Portland, Oregon, is a health solutions company dedicated to transforming health care by creating a person-focused and economically sustainable system. Cambia’s growing family of companies range from software and mobile applications, health care marketplaces, non-traditional health care delivery models, health insurance, life insurance, pharmacy benefit management, wellness and overall consumer engagement. Through bold thinking and innovative technology, we are delivering solutions that make quality health care more available, affordable and personally relevant for everyone. To learn more, visit cambiahealth.com or twitter.com/cambia.

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