1. Financing and Payment Strategies to Support High-Quality Care for People with Serious Illness
The National Academies of Sciences, Engineering, and Medicine
November 29th, 2017
Richard Popiel, MD, MBA
Executive Vice President and Chief Medical Officer
Cambia Health Solutions
© 2014 Cambia Health Solutions, Inc.

2. Enterprise Palliative Care Commitment
Regional Health Plans
2009
2011
2014
Our approach
This journey started in 2007 when the Cambia Health Foundation, Cambia’s 501(c)(3) grant-making organization, was founded. It has continued with strategic investment in companies that innovate health care delivery, and has advanced further with the development of the most comprehensive palliative care benefits in the industry for our regional health plans across four states.
We have focused all of these efforts on changing the experience of people with serious illness by empowering them with more control and changing the paradigm of health care.
Key to our approach is placing people and patients at the center of our planning and actions. When designing products and services and choosing philanthropic investments, Cambia’s leaders and employees look through a consumer lens to ask to ensure that palliative care:
• Makes their path through serious illness smoother and easier
• Focuses on what matters to patients rather than on what’s the matter with them
• Involves shared decision-making that helps them feel in control of their experience
• Provides an extra layer of support for patients and families that demonstrates the palliative care team has the best interests of patients and families at heart
Keeping the consumer at the center of our focus serves as our North Star, guiding our leaders and employees to challenge traditional thinking with innovation.
Consumer & Provider Outreach
© 2017 Cambia Health Solutions, Inc.

3. Funding Categories Personalized Care Support
With our regional health plans, we created what has been called the most comprehensive palliative care program in the nation (serving more than 2 million individuals). Our Personalized Care support program includes:
•Advance Care Planning
•Home Health Medical
•Home Health Psycho-Social
•Specialized Care Management
•Caregiver Benefit
© 2017 Cambia Health Solutions, Inc.

4. Health Plan Benefit For Serious Illness
Advance Care Planning
Home Health Medical
Home Health Psycho-Social
Specialized Care Management
Caregiver Benefit
Provider Grief Support
No homebound requirement for MA members
No prior authorization for therapies
All lines of business, any age, any diagnosis
We started with the expansion of benefits, including caregiver support -
•We looked at traditional health benefit plans to see if we had requirements.
•Thought about how we can extend benefits (extended home health visits, lifted benefits, etc.)
•Looked at how we could offer specialized nurse case managers for palliative care population
•Partnered with GNS to identify members of Medicare Advantage population that would benefit from personalized care support and extended benefits to pediatric palliative care
© 2017 Cambia Health Solutions, Inc.

5. Health Plan Palliative Care Universe Personalized Care Support Program
Adults
Commercial
2014/15
Pediatric
PCCM
2016
Medicare
2014 / 15
Survivorship
2017
Perinatal/Neonatal Hospice
2016
Members
Serious Illness
Advancing Illness
Terminal Illness
Grief and
Bereavement
2016 / 17
Caregivers
Providers
Benefit Support
2014 / 15
Resources & Training
2016 / 17
Community Engagement
2015
Reimbursement
2014 / 15

6. Summary
We have deployed resources and funding to support our personalized care program for individuals with serious illness
Our objective is to continually evaluate how best to serve these individuals so they can make personalized choices
While financial impact is always a consideration, our funding determinations are driven by what is best for our members
© 2017 Cambia Health Solutions, Inc.