Palliative Care with Peggy McGuire

Cambia Health Foundation President Peggy Maguire talks the ins and outs of palliative care and what the rest healthcare could learn from it.
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Palliative Care with Peggy McGuire

You can find more about Peggy McGuire here.

Palliative Care with Peggy McGuire – Podcast Transcription

Kelly MacLean: It’s the When You Die podcast. I’m Kelly MacLean. My guest today is Peggy McGuire. Peggy is the president of Cambia Health Solutions, a century old organization dedicated to transforming health care. They are a family of over 20 companies that work together to make the health care system more economically sustainable and efficient for people and their families. Their solutions empower more than 70 million Americans nation wide. 

Peggy is the champion of many causes. Chief among them is palliative care, which we explore in this conversation we had at the 2018 End Well symposium, one of America’s leading death and dying conferences. And for a recap of that, go to our website, In the meantime, enjoy Peggy.

Peggy McGuire: Cambia Health Solutions is a total health solutions company, located in Portland, Oregon. We have about 5,000 employees, and I think 20 something companies in our family of companies. Our reason for being, why we exist, is to serve as a catalyst to transform healthcare-

Kelly MacLean: Hmm.

Peggy McGuire: To make it more person focused and economically sustainable. So, Cambia rests on four pillars. There are four major pillars of the companies. One is the Foundation, which I lead. Second is our 100 year legacy as a health insurance company. Third is our consumer experience platform that we’re building that’s in beta testing right now, but will be launching to the market in 2019. And then the fourth one is a joint venture between Cambia and Blue Cross Blue Shield of North Carolina-

Kelly MacLean: Hmm.

Peggy McGuire: Where we’re jointly investing in solutions that will help people throughout their healthcare journey. So-

Kelly MacLean: That’s refreshing.

Peggy McGuire: Yeah. It’s a really … I mean, we’re … I think we’re … You hate to give yourself a compliment, but I think we’re a pretty innovative company that starts from looking at the experience that people have with the health care system. You know, we fundamentally have looked at places where the system is in need of change and of transformation, and clearly one of those areas is in helping guide families through serious illness care. 

Yeah, so, when we set up the Foundation back in 2007, we wanted to pick an area in health care that needed transformation. So … And based on personal experiences, we knew that this journey through serious illness and end of life-

Kelly MacLean: Yeah.

Peggy McGuire: Was in need of transformation. And that’s where we really started investing philanthropically to change the culture of health care.

Kelly MacLean: Kind of … Is the idea to take the focus away from trying to … I loved one of the doctors, one of … The second guy who spoke today was a doctor, and he said that … He was like, you know, he came in as a warrior in the war against death-

Peggy McGuire: That-

Kelly MacLean: Like it was his job to defeat death.

Peggy McGuire: Yeah. That so resonated with me. I think I have mentioned … I think … I’ve talked to so many people today, so forgive me if I’ve told you this before. But when I was 23 years old, my Dad was diagnosed with lung cancer, and it was the first time anyone in our family had ever been sick, or anything. You know, he was a pretty active guy, so it was a real shock to the family that he got sick. And so, we kind of fought the disease with everything that we could. That was the language. “You’re going to fight it.” “He’s a fighter. He’s not giving up-“

Kelly MacLean: Right.

Peggy McGuire: You know?

Kelly MacLean: Strong versus weak-

Peggy McGuire: Right, right.

Kelly MacLean: Kind of thing.

Palliative Care

Peggy McGuire: And so, we … He had chemo, he had radiation. By the time he was diagnosed, which was in October, he had a tumor in his lymph node, and the reason he found out was he was at the golf course, and he had trouble swinging the golf club, and so, he went to the doctor to have a look at that, and there was a tumor in his lymph node, and in his lungs, and in his brain. So, obviously, it was pretty far along, but we didn’t know better, you know? And no one suggested palliative care, no one suggested a different path. It was just like, let’s-


Kelly MacLean: And there’s no education you get in school, or anywhere-

Peggy McGuire: Right.

Kelly MacLean: To tell you that exists-

Peggy McGuire: Right.

Kelly MacLean: Or that you have, you know-

Peggy McGuire: Options. Right.

Kelly MacLean: You don’t have to do exactly what the doctor thinks is best.

Peggy McGuire: Right, right. And so, it’s just … That was a major … I think we’ve … That was a while ago, you know, and I think health care’s come along way since then, but-

Kelly MacLean: And then at the same time-

Peggy McGuire: It hasn’t.

Kelly MacLean: There are people my age-

Peggy McGuire: Yeah.

Kelly MacLean: Who have the same story about their dad, more or less.

Peggy McGuire: Yeah. So, I think … I mean, that’s why this investment that we’ve made through the Foundation, we’ve invested over $30,000,000 to advance the field of palliative care-

Kelly MacLean: Wow.

Peggy McGuire: Because we think that it has the potential to change that experience for people with serious illness, and their families. It really is focused on, you know, the goals of care. What matters to people, right? And what are their goals, values, and preferences? And then creating a treatment plan that helps them live well every day of their lives. So, I just … I feel like we’ve come a long way in health care, but there’s still a long way to go. 

Kelly MacLean: Mm-hmm.

Peggy McGuire: Right? And I think a lot of it depends on enabling and empowering consumers to put pressure on the system, because I think we’ve educated, or we need to continue to educate doctors, and spend more time on things like communication skills, and, you know, understanding that healing may not involve fighting the disease, but healing the spirit, right? There just needs … But consumers, and people with serious illness, and their caregivers, really have the opportunity to become educated, and to make demands on the way that they want to live and the way that they want to die.

Kelly MacLean: Yeah. So, the … What is the obstacle that you’re facing with that? And with, you know, people’s openness to palliative care to begin with?

Peggy McGuire: I think the biggest obstacle that I’m seeing is people are unfamiliar with palliative care. They tend to equate it with hospice. They think, you know … Palliative care is really appropriate at any age, and any stage of a disease. It’s really that extra layer of support that helps people with serious illness live well.

Kelly MacLean: It’s not actually … It’s very synonymous with, you know, just making you comfortable in your final days, but that’s not actually the definition of it.

Peggy McGuire: Right, right. So, that’s hospice-

Kelly MacLean: Yeah.

Peggy McGuire: What you’re talking about. And I think … You know, hospice is a specific Medicare benefit that requires a person to give up curative treatment, and to have a doctor certify that they only have six months to live. That’s not palliative care. You know, palliative care is best provided at the time of diagnosis, all the way through the journey with serious illness. I mean, I think it helps people deal with the diagnosis itself, right? To emotionally and spiritually respond to that kind of a diagnosis, and then to live well with the serious illness, you know? And they may recover from-

Kelly MacLean: Does it even improve their chance-

Peggy McGuire: Yeah.

Kelly MacLean: I mean, I always think it might even-

Peggy McGuire: There-

Kelly MacLean: Help them improve, to have that kind of care.

Peggy McGuire: There have been … There’s a major famous study, that is, people who receive palliative care actually live longer, and experience less depression than people who do not receive palliative care.

Kelly MacLean: Amazing-

Peggy McGuire: Yeah, and the survivor, their family members, are … Suffer less grief, and less depression as well.

Kelly MacLean: Do you remember where that study is from? That’s so cool.

Peggy McGuire: One of the studies I’m referring to is the Temel [00:09:23] study, but there’s been a number of studies, that I can send you some of the sites to them. I have that paper in my office.

Kelly MacLean: Yeah. That would be great.

Peggy McGuire: Yeah, yeah.

Kelly MacLean: That’s amazing, because it sounds like some people might refuse palliative care, because they see it as throwing in the towel, so to speak.

Peggy McGuire: I think that happens a lot. I recently just anecdotally talked to a dad at the airport, whose daughter had been diagnosed with breast cancer, and I was talking to him about my work in palliative care, and he said, “Oh, when they talked to my daughter about that, she said, ‘No, I’m not ready.’” Right? And so, it just shows there continues to be this misunderstanding about what it is.


Kelly MacLean: It must not be fully explained right, if that’s the case, I would think.

Peggy McGuire: I think that’s right. That’s right. And I think people talk about it in a number of different ways, so … And the way that people have talked about it has changed over the years-

Kelly MacLean: Mm-hmm.

Peggy McGuire: So, I think what we need is to get all of the people speaking the same language, and pull together as many different organizations as we can, and say, “What are the words that we want to use to describe this?” Somebody said, “Whoever turned squid into calamari should be hired-“

Kelly MacLean: Yeah. [laughs]

Peggy McGuire: [laughs] To change, you know-

Kelly MacLean: Brilliant.

Peggy McGuire: Palliative care.

Kelly MacLean: Yeah.

Peggy McGuire: We need a major social marketing campaign.

Kelly MacLean: Because it’s actually just a word that maybe makes some people’s hackles go up-

Peggy McGuire: Right.

Kelly MacLean: Because they only-

Peggy McGuire: Right.

Kelly MacLean: Know it in reference to when grandma was in hospice, or whatever-

Peggy McGuire: Right. Exactly.

Kelly MacLean: Interesting. 

Peggy McGuire: Empathy is sometimes lacking in health care. You know, we talk about … And I know that it leads to dissatisfaction for providers as well, because I think people go into medicine because they want to help, and they want to heal, and then they get into our broken system, and they have to see people at 15-minute increments. Empathy in health has been removed from health care, and it shouldn’t. It’s the … One of the most important. One of the most personal things that we deal with is our health and well being, but we have made it difficult to our healers to be empathetic in the way that we’ve set up payment systems, and etc.  So-

Kelly MacLean: As well as their burn out, which one of the speakers was-

Peggy McGuire: Yeah, yeah.

Kelly MacLean: Just talking about.

Peggy McGuire: Yeah. I mean, because we’re asking them to do a lot, right?

Kelly MacLean: The doctor will make you feel like they don’t have time for you, and it is also true that they don’t really have time for you-

Peggy McGuire: Right.

Kelly MacLean: Because that’s not the way they’ve been told to schedule-

Peggy McGuire: Yeah. That second speaker, I think … That really resonated with me, because of my dad’s experience, and I have a brother in law who’s a doctor, and because of his experience-

Kelly MacLean: Mm-hmm.

Peggy McGuire: Working with people, and seeing people, you know, frequently. So, palliative care returns empathy to health care-

Kelly MacLean: Yeah.

Peggy McGuire: And it really starts with that one-on-one conversation, and the communication, and the relationship between a doctor and a patient. Like a true relationship, where they talk about what matters to you, as opposed to what’s the matter with you.

Kelly MacLean: Right.

Peggy McGuire: And then … And the patient feels heard and respected. And then the palliative care doctor helps to create a treatment plan that honors the patient’s wishes for their health and well being. And I just … I think that the lesson palliative care has to teach the rest of the health care, is to slow down, to listen, to be empathetic, to realize that you’re treating a person and not a disease. That’s, I think, you know-

Kelly MacLean: Yeah.

Peggy McGuire: When we treat body parts, we lose sight of the fact that we’re treating real people.

Kelly MacLean: Mm-hmm. It reminds me very much being seven some months pregnant of the, you know, the kind of care that I’ve received from doctors. And I had a really great doctor, but I just switched to midwifery care, and I’m really glad I did, because they actually sit with me, and talk for longer periods of time, they’re really curious about, you know, a previous injury I had, or the fact that I’m in grief-

Peggy McGuire: Right.

Kelly MacLean: You know, or whatever-

Peggy McGuire: Right, right. Your whole person.

Kelly MacLean: Yeah. 

Peggy McGuire: Yeah.

Kelly MacLean: They’re taking that into account, and that is a part of-

Peggy McGuire: Yeah.

Kelly MacLean: What they should be treating.

Peggy McGuire: Right, right.

Kelly MacLean: They’re getting a better idea of what they’re treating. So-

Peggy McGuire: Yeah. Yeah.

Kelly MacLean: Just that shift-

Peggy McGuire: Yeah.

Kelly MacLean: Seems like something similar would be helpful throughout-

Peggy McGuire: And how … I mean, doesn’t it seem so obvious that that should be-

Kelly MacLean: It seems-

Peggy McGuire: A part of our health care?

Kelly MacLean: Completely obvious.

Peggy McGuire: It seems so funny.

Kelly MacLean: And it probably was people’s first intention. It probably was that way in the beginning-

Peggy McGuire: Right.

Kelly MacLean: And more of like, a hand-in-hand healer-

Peggy McGuire: Right.

Kelly MacLean: Relationship-

Peggy McGuire: Right.

Kelly MacLean: And then it just has gotten so far from anything intuitive-

Peggy McGuire: Yeah. And it’s funny … I don’t know if it’s in the way that we train doctors, but I’m sure that there’s room to improve that, to help with communication skills, to help with thinking about the patient as a whole person, right?


Kelly MacLean: Completely, and also how they’re treated.

Peggy McGuire: Right.

Kelly MacLean: My ex is a doctor, and we were together when he was in medical school, and I was really shocked to see what he went through-

Peggy McGuire: Yeah.

Kelly MacLean: And how he was treated. And when you’re treated like, you’re so unimportant-

Peggy McGuire: Right, right.

Kelly MacLean: Then it kind of spreads out, I think, as well.

Peggy McGuire: Yeah. It’s interesting … Long ago … I’m a lawyer by training, and I think that in law school they told … I, in my past life, was, I think, a really good writer, and a creative writer, and then when I was in law school, they taught me to write like a lawyer, and to think like a lawyer, so you can construct really-

Kelly MacLean: Yeah.

Peggy McGuire: Great arguments-

Kelly MacLean: Yep.

Peggy McGuire: Prove, you know … How do you prove this point? And I think I had to relearn some creativity-

Kelly MacLean: Uh-huh.

Peggy McGuire: After a long period of time, because you were rewarded for thinking a certain way.

Kelly MacLean: Right. So you have a Pavlovian reaction to it.

Peggy McGuire: Right, and that’s what the law firms are looking for. And I don’t know, because I’m not a doctor, but I imagine there’s a similar process-

Kelly MacLean: Mm-hmm.

Peggy McGuire: For medical students, and so, then, you know, somebody wakes up mid-career, and says, “Huh, what happened to empathy?” You know?

Kelly MacLean: Yeah.

Peggy McGuire: “This isn’t why I went to med school.” Right? “I came to help people.” And that may cause, you know, suffering even for physicians, and healers.

Kelly MacLean: Right. That makes a lot of sense.

Peggy McGuire: Yeah.

Kelly MacLean: So, you spoke at the end of your presentation about, you know, kind of envisioning a more, you know, sane, healthy, whatever you want to call it, health care system, and I was wondering if you would share with us what that vision looks like to you?

Peggy McGuire: I think it’s a lot more consumer driven. You know, I think it’s not one size fits all, but I think it’s trying to figure out a way to personalize health care, and make it relevant to people at different stages of their life. Whether it’s birth, you know, or being a new mom, to, you know, being a mom with two kids, and whatever, to, you know … It’s being present at each major phase of someone’s life, but being there in a way that’s not, “We’re smarter than you. We’ll tell you what to do,” but more, “We will honor you through your life journey, and we will help you navigate this complex system.” But it’s fundamentally respecting people, and respecting people as intelligent, whole, human beings, and personalizing care according to what’s important to them.

Kelly MacLean: Yeah, and what effect do you think that would have on the patient, and society as a whole?

Peggy McGuire: I think there’d be greater sense of well being, greater satisfaction, both for consumers, for family care givers, and ultimately, I think, for clinicians as well.

Kelly MacLean: Yeah.

Peggy McGuire: So, I think we need to return empathy to health care.

Kelly MacLean: Hmm. That’s a beautiful vision, and mission.

Peggy McGuire: Yeah. [laughs] Yeah.

Kelly MacLean: Well, I’ll wrap us up, but I wanted to ask, also, for people who don’t really know much about palliative care, who is eligible for palliative care, and like, who is actually receiving it?

Peggy McGuire: Well, anyone with a life limiting illness, or a serious illness, such as a cancer diagnosis, heart disease, COPD, you know, a serious illness, and it can be … It’s best provided alongside of curative care, early on in the trajectory of a disease, so that it can ease the burden through serious illness. Also, eligible for palliative care are people who have been injured, like, let’s say in a car accident, and they are suffering, and trying to heal, palliative care helps them in that process as well. So, the other thing I would say is palliative care is not limited to people with old age-

Kelly MacLean: Hmm.


Peggy McGuire: Or people who are actively dying. Children can receive palliative care. New moms can receive palliative care, you know, there’s neonatal-

Kelly MacLean: Mm-hmm.

Peggy McGuire: Palliative care, and there’s pediatric palliative care, and it requires different … You know, kids are not mini adults. Kids are-

Kelly MacLean: Yeah.

Peggy McGuire: Kids with serious illness are dealing with different issues, and their siblings are affected, and their whole families are affected. So, palliative care is really … People who are eligible, it’s any stage of … Any age, any stage of a serious diagnosis, or injury, and that’s it. I mean, people … It’s not like hospice, where people are limited to receive it if they only have six months to live.

Kelly MacLean: Yeah.

Peggy McGuire: Yeah.

Kelly MacLean: And what does it look like? I’m sure it looks different, and all of those cases were so different from one another-

Peggy McGuire: Yeah.

Kelly MacLean: But overall?

Peggy McGuire: I think fundamentally it’s specialized communication skills. So, communicating in a way that understands the whole person, and what’s important to that person, and helping them to understand the different choices that they make, so they have informed choices about their care. And then it’s relief of pain, and symptom management. So, the burden of serious illness. So, it’s helping people with either the pain that’s brought about by their disease, or the pain that’s caused by the treatment-

Kelly MacLean: Mm-hmm.

Peggy McGuire: So, you know, chemotherapy makes people really sick, and so, palliative care will help ease those physical burdens of the treatment.

Kelly MacLean: Yeah. Makes sense.

Peggy McGuire: Yeah.

Kelly MacLean: Wonderful. Well, the last … I often like to ask people, if you have one wish for your own death, what would that be?

Peggy McGuire: Well, I’m going to go back to Justin, and his talk this morning. It’s like, I want to be greeted at the end of my journey, by the people that love me-

Kelly MacLean: Mm-hmm.

Peggy McGuire: And the people that I’ve loved. And … Yeah, that’s my one wish. Yeah, yeah.

Kelly MacLean: Thank you so much.

Peggy McGuire: Thank you.

Kelly MacLean: This was so great-

Peggy McGuire: Thanks for taking the time to talk with me.

Kelly MacLean: Yeah!