Latest / Becker’s Payer Issues Podcast / Dr. Steve Friedhoff, Senior VP of Healthcare Services at Blue Cross Blue Shield of North Carolina

Transcript

Dr. Steve Friedhoff, Senior VP of Healthcare Services at Blue Cross Blue Shield of North Carolina · Becker’s Payer Issues Podcast

0:00
Hello, everyone. This is Jacob Emerson with the
0:02
Becker's Pay Your Issues podcast.
0:04
Thrilled today to be joined by doctor Steve
0:06
Friedhoff, who is the senior vice president of
0:08
health care services at Blue Cross and Blue
0:11
Shield of North Carolina. Doctor Friedhoff, thank you
0:13
so much for taking the time to be
0:15
with me on the podcast today.
0:17
My pleasure. Thank you, Jacob. Yeah. Absolutely. And
0:19
before we dive into everything we wanna talk
0:21
with you about, Steve, can you tell us
0:22
a little bit more about yourself, your background
0:24
in health care, and what it is that
0:26
you're doing today at Blue Cross North Carolina.
0:29
Sure. Happy to. So I'm a family physician
0:32
by backgrounds. I practiced for about twenty years,
0:35
either on a full time or a part
0:36
time basis
0:38
in a combination of community practices and academic
0:41
practice. I was the medical director of a
0:43
family medicine residency program at one point.
0:46
I've had a fair amount of experience in
0:49
hospice and palliative care and,
0:52
joined Blue Cross of North Carolina about four
0:56
almost four years ago.
0:57
And my areas of responsibility as senior vice
1:00
president of health care services
1:02
include all things related to medical care management,
1:05
behavioral health,
1:07
pharmacy,
1:08
contracting with our provider network, including all of
1:10
our value based care programs,
1:12
our quality programs, including
1:14
stars and risk adjustment,
1:17
payment integrity and accuracy, and our affordability programs.
1:20
So it's a pretty broad focus, but, one
1:23
that very much
1:25
remains, focused on affordability,
1:28
access to health care, and quality outcomes.
1:32
Fantastic. Well, I appreciate that overview, Steve.
1:35
The first thing we wanted to talk with
1:36
you about is Blue Cross of North Carolina
1:39
being instrumental in partnering with the UNC School
1:42
of Medicine to address
1:44
North Carolina's health care provider shortage
1:46
by training veterans for medical careers. So talk
1:50
to us a little bit about this initiative.
1:52
How has it evolved over the years, and
1:54
and what's the impact that you've seen in
1:56
terms of filling those critical gaps in care
1:58
in in rural and
2:00
underserved areas of your state?
2:03
Sure. Happy to. UNC has been a great
2:05
partner to us on on a number of
2:07
different levels.
2:08
But this specific partnership with the UNC School
2:11
of Medicine, as you indicated,
2:14
was to develop a physician assistant program
2:17
that was really trying to address two different
2:19
problems with a single strategy.
2:21
First, you know, we know there's a statewide
2:23
gap in health care providers,
2:26
in North Carolina, like in many, many other
2:28
states,
2:29
particularly in our more rural areas.
2:31
And then the the second is helping returning
2:34
veterans,
2:35
with medical training
2:36
to define careers in civilian health care across,
2:40
North Carolina.
2:41
So this program was initially created in 2012.
2:44
I believe the first class graduated in 2015.
2:48
So this is the, the tenth anniversary.
2:50
And the idea,
2:52
was to recruit nontraditional
2:54
students
2:55
like veterans or other North Carolina residents who
2:57
are the, over the age of 26.
3:01
So students in this program
3:03
train for careers,
3:05
in fields ranging from primary care to orthopedics,
3:08
cardiology,
3:09
emergency care, and and mental health. And, ultimately,
3:12
they can choose to practice,
3:14
wherever they they want. But the program is
3:16
designed to create a pipeline of providers,
3:19
for medical
3:20
medical deserts all across North Carolina.
3:23
And since in inception in that first graduating
3:26
class of twenty fifteen, we've had a 40
3:28
physician assistants who graduated from the UNC physician
3:32
assistance program
3:33
and gone on to careers throughout the state
3:35
in the OR, the ER, and a variety
3:37
of different clinic settings.
3:39
Wow. I mean, that's an amazing number that
3:41
you just shared, and it sounds like this
3:43
is a very impactful
3:44
program within the states.
3:46
I wanted to ask though, you know, many
3:48
states, including North Carolina, as you know, they
3:50
don't recognize military medical credentials
3:53
despite the vast experience that military medics gain
3:56
when they're in the service.
3:58
So how do you envision expanding this partnership
4:01
to further recognize and leverage the skills that
4:03
these veterans have within the civilian health care
4:06
system?
4:08
Yeah. This a number of years ago in
4:09
a different role, this was actually a pretty
4:12
significant
4:13
moment, for me.
4:15
In in a prior role, I I worked
4:17
near a very, very large,
4:19
military
4:20
base, and we recruited a significant
4:23
number of
4:25
veterans,
4:26
from that that population.
4:29
And to your point, I never realized
4:31
that
4:32
there was no crosswalk between
4:35
military medical credentials
4:36
and
4:38
in civilian life. And, you know, one story
4:40
in particular that just I've hit home with
4:43
me and really carried with me to this
4:44
day is I interviewed and ultimately hired an
4:47
individual
4:48
who is the only medic
4:50
on a destroyer.
4:53
And,
4:54
you know, as part of that role, I
4:55
mean, fortunately, it
4:58
it it was less about, you know, treating
5:00
injuries and anything related to combat, but more
5:03
about, you know, having hundreds or thousands of
5:06
individuals
5:06
in a very isolated place where you didn't
5:09
have access to
5:10
specialists or, you know, lots of other facilities.
5:13
And this individual is responsible for taking care
5:16
of
5:17
all the different illnesses and accidents and injuries
5:20
that could happen in any small to medium
5:24
sized population.
5:25
Yet when he left the service,
5:28
none of that training, none of that mattered.
5:31
So at the end of the day, you
5:32
know, he had tremendous
5:34
clinical experience, and we ultimately,
5:37
found him a role that was a great
5:38
fit where we could leverage that experience,
5:41
but in a way that did not require
5:43
a a license.
5:45
But that that was just such an eye
5:46
opener to me. And North Carolina has several
5:49
military bases as as you know, and the
5:51
fourth largest military population in the country. And
5:55
about 20,000 active military members transition to civilian
5:58
life every year.
6:01
And, you know, we know from the UNC
6:03
PA programs,
6:04
you know, a number of us from our
6:06
own personal experience that, you know, veterans bring
6:09
an incredible amount of, you know, discipline, resourcefulness,
6:13
commitment, and compassion to their roles.
6:16
And all of these characteristics,
6:18
you know, have the potential to make for
6:20
an exceptional
6:21
health care provider.
6:23
So helping them move into civilian health care
6:25
is is really a win for our state.
6:27
We get some great medical professionals and we
6:29
improve access to care and we obviously help
6:32
to further, you know, individuals,
6:35
careers.
6:36
So we we do support veterans and active
6:39
military service members and their families across our
6:42
company in a number of additional ways at
6:44
Blue Cross North Carolina.
6:46
In addition to the PA program, we also
6:49
participate in the SkillBridge program,
6:52
which provides soldiers with, civilian work experience during
6:55
the last six months of their military career
6:57
to help them with that transition,
6:59
out of the service.
7:01
We also participate in the Department of Defense's
7:04
military spouse program,
7:06
and that helps connect military spouses who often
7:09
have to relocate
7:10
you know, to find, meaningful careers in their
7:12
new locations.
7:14
And we also have a very, very active
7:16
employee network called VetNet
7:18
that's dedicated to uplifting,
7:20
our very proud local community of veteran employees
7:23
to increase their sense of belonging at Blue
7:25
Cross of North Carolina. So it's through all
7:27
these different initiatives that we really try to
7:30
help leverage the the skills of veterans and
7:32
all that they can bring to North Carolina.
7:35
Absolutely. And that was such a great anecdote
7:37
that you shared about about the medic. So
7:38
I appreciate that, Steve. And, really, it's great
7:41
that you're able to to turn their clinical
7:43
expertise,
7:44
into a benefit for the wider health care
7:46
system.
7:47
If we were taking a step back, can
7:49
you explain why Blue Cross North Carolina has
7:52
invested so much in supporting the health care
7:55
workforce in the state? I know you briefly
7:57
touched on this, but but why is this
7:58
such an important,
7:59
move for the company and and any other
8:01
steps you'd share in terms of how Blue
8:04
Cross is supporting providers across North Carolina?
8:08
Sure. Well, you know, Blue Cross in North
8:10
Carolina as a single state Blue Cross plan,
8:14
we're committed to improving the health care for
8:16
all of North Carolinians
8:18
wherever they live. And and, frankly,
8:21
you know, whether they insured are insured by
8:23
Blue Cross of North Carolina today,
8:26
or not.
8:27
And right now, we know that nearly 3,000,000
8:29
people in North Carolina live in places that
8:32
are deemed health professional shortage areas,
8:36
Meaning, it's not just about not having enough
8:38
physicians, there's not enough nurses or other providers
8:42
to meet demands, including
8:44
physicians.
8:45
And this is particularly true in many of
8:47
our rural communities
8:48
and where it's particularly difficult to attract and
8:51
retain health care professionals in some of those
8:54
settings. So that's one of the reasons we've
8:56
made significant investments in the health care workforce.
9:00
It's one of the more impactful ways we
9:01
can keep communities healthy, keep health expenses down,
9:04
and really try to take more and more
9:06
of this further upstream.
9:08
And colleges and universities,
9:09
you know, they play a critical role in
9:11
training this next generation.
9:13
So it's establishing
9:15
those kinds of partnerships where we really feel
9:17
like we can help make a difference and
9:19
move the needle in in North Carolina.
9:22
So I'll highlight a couple of our key
9:24
investments.
9:25
One of them through, again, through UNC is
9:28
the School of Medicine's Primary Care Rural Advancement
9:31
Program.
9:32
This investment has made a real difference in
9:34
Rockingham County. It's
9:36
increasing,
9:37
patient centered primary care. It's recruiting more residents
9:41
to enter the profession in Rockingham County and
9:43
neighboring counties, and it's provided,
9:47
many different opportunities for students studying medicine, nursing,
9:50
pharmacy, and other health professions to better prepare
9:54
them for practice in a in a rural
9:56
community.
9:57
Another example is the Winston Salem State University's
10:01
division of nursing. It's one of the top
10:03
nursing programs in the country.
10:06
And,
10:06
Winston Salem State used this funding to provide
10:09
scholarships,
10:10
expand access to care, and enhance some of
10:13
their own technology
10:14
infrastructure
10:16
to help better prepare the nurses of the
10:18
future.
10:19
Third example would be North Carolina A and
10:22
T State University School of Nursing.
10:24
This particular investment
10:26
worked toward, or excuse me, went towards scholarships,
10:29
new equipment, new technology,
10:32
all to encourage,
10:34
student development,
10:35
and addressing those nursing shortages
10:38
while providing them with access to, you know,
10:41
the most modern tools as part of their
10:43
their studies.
10:45
So,
10:46
you know, as part of what we do
10:48
to try and expand the workforce, we also
10:49
have to focus on the workforce that exists
10:52
and continue to make it a more attractive
10:53
place to practice.
10:55
And when you think about
10:57
a physician's
10:58
mindset or other providers mindsets, typically,
11:02
there are three things top of mind for
11:04
them in terms of their their goals and
11:06
how we can hopefully best support them. One
11:09
is, you know, certainly top of the list
11:11
is delivering the best possible patient outcomes.
11:15
Second is reducing their administrative burden associated with
11:19
providing that care. And third is receiving a,
11:22
you know, fair and reasonable payment for the
11:24
services that they do
11:26
provide. So we
11:28
a lot of our strategy is how we
11:30
collaborate providers
11:31
to meet these three aims and put those
11:33
kind of supports in place. And one of
11:35
the things I'm particularly proud of is something
11:38
called our Blue Premier program.
11:40
That was launched in 2019,
11:42
and it's our value based care program
11:45
with the goal of enrolling as many of
11:47
our members as possible with physicians
11:50
who are in a value based relationship with
11:53
us.
11:54
And as of today, our Blue Premier program,
11:57
every single one of our large systems in
11:59
the state,
12:00
is part of Blue Premier.
12:02
About two thirds of our primary care physicians
12:05
are part of Blue Premier as well. And
12:07
about the same percentage of our commercial and
12:10
Medicare members,
12:12
actually see a physician who is part of
12:15
Blue Premier. And the whole idea is to,
12:20
provide incentives and also hold doctors and hospitals
12:23
accountable
12:24
for meeting, certainly first and foremost, quality measures,
12:27
but also
12:28
affordability measures.
12:30
And making their payments based on,
12:33
improving care delivery rather than just the simple
12:36
number of tests and procedures,
12:39
performs.
12:40
And by doing so, we reduce the number
12:43
of unnecessary ER visits. We reduce the number
12:46
of
12:46
unnecessary hospitalizations
12:48
or rehospitalizations
12:50
and improve
12:51
the health of our members.
12:53
And one of the things that, really sets
12:55
this apart is that
12:57
any of the cost savings we share significantly
13:00
with with physicians and other providers who are
13:03
part of Blue Premier.
13:04
So since it's launched,
13:06
we have saved over $800,000,000
13:09
in medical medical costs.
13:11
And about two thirds of that actually goes
13:13
directly back to physicians as an incentive payment.
13:17
The other third goes to keep our rates
13:19
lower to help,
13:20
make health care more affordable for all the
13:23
people in in in North Carolina.
13:25
So,
13:26
you know, I think that's that's one of
13:28
the ways we have really tried to work
13:29
with providers.
13:31
Another example of that is to help free
13:34
them up from some of the administrative
13:35
burden.
13:36
And one of the ways we have done
13:38
that was by entering into a joint venture
13:40
in 2021
13:42
to form an an organization called Allo.
13:45
And the whole idea behind Allo was to
13:48
make it a,
13:50
make physician independence
13:52
something that is
13:54
financially viable
13:55
and is administratively
13:57
unburdensome
13:58
as possible. So what Allo does is provide
14:01
administrative support,
14:03
high-tech tools,
14:04
infrastructure,
14:06
and similar that reduce the administrative burden on
14:09
physicians,
14:10
allow them to focus on
14:12
taking care of patients, which is what most
14:14
of them signed up, you know, to do
14:16
anyway in the first place,
14:18
and,
14:19
allow them to remain independent
14:21
in a way that is
14:24
economically
14:25
viable and also viable from a work life
14:28
balance kind of, perspective.
14:31
So, you know, I guess maybe the last
14:32
thing I'll I'll I'll say on this topic
14:34
is that you you may have heard that
14:37
we have recently modernized our ninety two year
14:39
old structure and announced the creation of Curacor
14:42
Solutions,
14:43
which is a North Carolina based not for
14:45
profit parent company.
14:47
And what this organization
14:49
does or this reorganization
14:51
does is allows Blue Cross of North Carolina
14:54
to continue to make investments in
14:57
organizations like Allo
14:59
to deliver on making health care more affordable,
15:02
accessible, and easier to navigate
15:04
while still remaining a not for profit mission
15:07
driven company.
15:08
And,
15:10
you know, certainly not changing anything that is
15:12
fundamental to
15:14
Blue Cross of North Carolina
15:15
as a more traditional payer within the state.
15:19
Certainly. Well, clearly, so much impactful work going
15:22
on at Blue Cross of North Carolina. So
15:24
appreciate you detailing everything that's happening across the
15:27
enterprise for us, Steve.
15:29
Before we go, what else are we missing?
15:31
We've got a lot of other health plan
15:32
leaders listening in from all over the country.
15:34
Any final bits of advice or or final
15:36
thoughts that you wanna share with them?
15:39
Well, I think a lot of what I've
15:40
spoken about, you know, without well, maybe saying
15:42
the actual phrase is, you know, we're trying
15:45
to help our members continuously find the right
15:48
level of care at the right time, at
15:50
the right place, and hopefully for for the
15:52
right price at the same time. But one
15:54
thing maybe I would love to touch on
15:56
just because it's something I care, you know,
15:58
very, very deeply about
16:00
is youth mental health.
16:03
You really can't go a day or a
16:06
week or longer without hearing something, reading something
16:09
about the youth mental health crisis,
16:12
in this country.
16:13
And when you hear statistics
16:15
like forty percent
16:17
of, you know, high school or similar youth
16:20
report feeling sad or hopeless,
16:23
every day, and an incredible number of
16:27
youth of that age have seriously considered
16:31
harming themselves or suicide.
16:34
It is clear we have a significant, significant
16:37
problem to address. And, you know, these are
16:40
the individuals that are next generation. They're the
16:42
next generation of adults, of parents, of of
16:45
leaders. And it's really frightening when you hear
16:48
those kinds of statistics.
16:50
So one of the areas we have really
16:53
tried to focus
16:55
on in the last few years
16:56
has been youth mental health and it's through
16:59
a couple of different,
17:00
avenues.
17:02
One I'll just touch on briefly is a
17:04
program called behavioral health total care.
17:07
And that's a program that engages the parents
17:10
of children
17:11
who we notice are either going to emergency
17:14
departments or other settings with with mental health
17:16
needs. And the whole idea there is it's
17:19
behavioral health childcare serves as a central point
17:22
of coordination
17:23
and support
17:25
for the members, the youth, their parents,
17:28
that really addresses their needs on a whole
17:30
person health
17:32
kind of basis.
17:34
Operates on the principle principles of finding a
17:37
behavioral health home
17:39
that prioritizes things like continuity of care, integrating
17:42
with other services that provide a much more
17:44
personalized approach, and really helping them get the
17:47
kind of support that meets their unique needs
17:50
and
17:51
meets them where they are.
17:52
So through this team, you know, we've have
17:55
individuals who can engage with them as care
17:57
navigators,
17:58
as peer support specialists,
18:01
and a variety of other means to ensure
18:03
that they're getting to the right
18:05
excuse me, the right providers at the right
18:07
times.
18:08
And
18:09
we're we're finding the demand for these services,
18:11
not surprisingly, has been very, very high. And
18:14
we also find that the parents,
18:17
are responding because we understand that it's very,
18:20
very challenging for them when,
18:22
you know, one of their own children has
18:25
mental health needs.
18:27
Another component of this that is very much
18:29
focused on youth behavioral health, but, is also
18:32
available to all of our insured
18:34
is a behavioral health care navigation service.
18:38
And
18:39
one of,
18:40
the things that I would say is unique
18:42
about behavioral health is that, yes, there's a
18:45
workforce
18:46
shortage.
18:47
And yes, it's always important to find the
18:49
right provider.
18:51
But unlike a lot of other specialties, the
18:53
behavioral health
18:55
relationship with a provider, whether it's a psychiatrist
18:57
or a social worker or other type of
18:59
a provider,
19:00
you know, it's it can be very intimate.
19:02
You're sharing very,
19:04
you know, closely held details of of of
19:06
your life and the person really needs to
19:08
be a good fit.
19:10
And
19:11
one of the best predictors
19:12
of
19:13
someone receiving appropriate behavioral health follow-up care is,
19:18
you know, not surprisingly,
19:19
you know, how they felt about their behavioral
19:22
health provider, whether they they clicked. So the
19:24
whole idea of our behavioral health navigators is,
19:27
first and foremost, there's no wrong front door.
19:30
Patients can self refer, a provider can refer
19:32
them, one of our own case managers can
19:34
refer them. But once our behavioral health care
19:36
navigators
19:37
are involved,
19:38
we'll not only understand what their clinical needs
19:41
are to get them to the right provider,
19:43
we also want to understand their preferences. What
19:45
are they looking for in a behavioral health
19:48
provider,
19:49
counselor, a psychiatrist?
19:51
You know, what's important to them? Is it
19:53
important for them to have a similar backgrounds
19:55
to, you know, to to to look like
19:57
them, to understand what they've gone through? And
20:00
our our care navigators,
20:03
you know, really leverage
20:04
being local to understand what our network looks
20:06
like and get them connected to the right
20:09
behavioral health provider,
20:11
help them get an appointment, make sure the
20:13
appointment occurred,
20:15
get them the follow-up they needed,
20:17
and hopefully set them on a on a
20:19
positive path. So I'm sorry. I know that
20:21
was kind of a long answer to to
20:23
your question, but, I'm just so passionate about
20:25
behavioral health in general and, you know, youth
20:27
behavioral health, specifically. So,
20:30
hope that was helpful.
20:32
Yeah. No. Absolutely. Very helpful. Your your passion
20:34
is coming through the screen, Steve. So I
20:36
appreciate you calling out this this pressing and
20:39
important issue and explaining for us how Blue
20:41
Cross of North Carolina is tackling these challenges
20:44
head on for your members and for the
20:46
wider communities that you serve. I also wanna
20:48
thank you for taking the time to sit
20:50
down with us and for sharing your insights
20:52
with our listeners. We really appreciate it.
20:55
Yeah. Thank you, Jacob. Appreciate the the time
20:57
to participate.
20:58
And if you'd like to listen to more
21:00
podcasts from Becker's HealthCare, you can visit beckershospitalreview.com.