Latest / CareTalk: Healthcare. Unfiltered. / How Payors Can Address Healthcare's Iron Triangle w/ Blue Cross Blue Shield President and CEO, Sarah Iselin | HealthBiz Briefs

Transcript

How Payors Can Address Healthcare's Iron Triangle w/ Blue Cross Blue Shield President and CEO, Sarah Iselin | HealthBiz Briefs · CareTalk: Healthcare. Unfiltered.

• 0:00
  Massachusetts set the stage for Obamacare by introducing near -universal coverage and new payment rules.
• 0:06
  Now the Commonwealth is wrestling with how to make care affordable and accessible, plus how to address the social determinants of health.
• 0:13
  What are health plans doing to solve these problems, and how successful have they been so far?
• 0:24
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• 1:05
  Welcome to Health Biz Briefs.
• 1:07
  I'm David Williams, president of Health Business Group here with Sarah Island, president and CEO of Blue Cross Blue Shield of Massachusetts, one of the most innovative health plans in the country.
• 1:17
  Welcome, Sarah.
• 1:17
  Thanks for that.
• 1:19
  I will lean into continuing to be one of the most innovative plans in the country.
• 1:23
  No pressure.
• 1:24
  Sounds good.
• 1:25
  Well, my first question for you, is what initiatives are you pursuing in women's health?
• 1:30
  And why is that such an important area of focus?
• 1:33
  Well, I'm going to start by saying it's not just because I'm a woman, but it is because it's been a neglected part of the health care system.
• 1:41
  Believe it or not, it was only in 1993.
• 1:44
  that the National Institutes of Health required that women be a part of clinical trials.
• 1:51
  And there's still, we only represent about 40 % of participants in clinical trials.
• 1:57
  We're half the population.
• 1:59
  We're healthcare decision makers in most families.
• 2:02
  But it's also been really important to us as an employer.
• 2:05
  I we as a health plan, we buy health insurance on behalf of our employees and our workforce is almost three quarters women.
• 2:12
  So this is another way in which we're really trying to just lean in and make a contribution to inspiring other parts of the healthcare system to make more progress on things that sometimes feel like unmentionables that people don't want to talk about, like menopause or endometriosis.
• 2:32
  We've gotten better about talking about things like infertility and destigmatizing those, but there's still a huge unmet need.
• 2:40
  amongst women for things that affect our productivity and the ways in which we show up at work.
• 2:46
  And so we're really excited about leading in this area.
• 2:49
  So we sometimes hear about the iron triangle in healthcare, quality, access, affordability, pick any two.
• 2:59
  Should we be satisfied to settle for just two of those or maybe even only one?
• 3:03
  Or is it possible to get some combination of all three?
• 3:08
  I think we have to just keep working to get some combination of all three and holding them in some kind of balance.
• 3:15
  And it's really hard.
• 3:17
  So very much on my mind right now is affordability.
• 3:20
  So as a health plan, that's job one for us.
• 3:24
  And I think we've got some real reason to be concerned about the affordability of health care in this particular moment in time as we look at the cost trends that we're experiencing and seeing in our own book of business.
• 3:36
  It's now growing at about three times the rate of growth in the overall economy.
• 3:40
  And that has real consequences for employers in this country, for government as a purchaser of health care, but also just for consumers who've been asked to pay more and more towards the health, the cost of health care over the most recent decades.
• 3:55
  And so I think we need to focus on that really deeply and profoundly in partnership with all of the parts of the health care system while also not losing sight of, we're doing that because we want to protect health care access.
• 4:06
  And we're also doing that because we have value access to high quality, equitable, affordable healthcare for everyone in the United States.
• 4:17
  Steward Healthcare has been a name in the news in Massachusetts and nationally.
• 4:21
  They've recently declared bankruptcy.
• 4:24
  How does that affect Blue Cross Blue Shield of Massachusetts and your members?
• 4:28
  Yeah.
• 4:30
  So it's an area of pretty profound concern.
• 4:33
  This is a state where access, in spite of our having one of the lowest on insurance rates in the country, people are finding it hard.
• 4:40
  I'm wait times for appointments, particularly in some specialties or for primary care, are longer than we want them to be for access to behavioral health specialists.
• 4:49
  And so losing, potentially losing more capacity in this state is of deep concern to everyone who lives there.
• 4:57
  And our provider system is vulnerable right now, both in Massachusetts, but more broadly, still recovering from the impacts of the pandemic, whether that's staffing shortages, whether that's their financial situation.
• 5:09
  And so we are concerned.
• 5:12
  So we've been leaning into really supporting our members as they navigate what is a scary time.
• 5:18
  We've been leaning into a deep and collaborative relationship with state government.
• 5:23
  And we haven't added a level of complexity because they're also our account.
• 5:26
  So we are the health plan for it had been about 40 ,000 steward employees.
• 5:33
  So we also have a lot of concern for all of those employees who are probably wondering what's going to happen to them.
• 5:39
  So we've been planning for this for a while and are now putting all of those plans into effect.
• 5:47
  We've called every member when they announced the closure of Kearney and another hospital here in Massachusetts.
• 5:53
  We called every member that we knew had a surgery or procedure scheduled in the next month to say, how can we help?
• 6:01
  And so that's just one concrete example of the ways in which we're really trying to show up for our members in a vulnerable and scary time.
• 6:08
  Well, that's it for the latest Health Biz Brief.
• 6:11
  If you like what you hear, check out my Health Biz Podcast for a full -length interview with Sarah about her life and career.
• 6:17
  Sarah Islin, president and CEO of Blue Cross Blue Shield of Massachusetts.
• 6:21
  Thanks for joining me today on Health Visbriefs.
• 6:24
  Thanks for having me.