​ interview

Creating a WellCare Ecosystem

Craig Samitt, MD, MBA

Blue Cross Blue Shield of Minnesota

As a payer, you have a fairly unique perspective on the pandemic. What are some of the most surprising things you have seen that you can share with physicians?

In our professional lifetime, we have not seen, or been taught, how to deal with one crisis − let alone many simultaneous ones. A pleasant surprise for me, both as a physician and payer, has been how much the local care delivery and business communities have rallied and worked in lockstep to care for the sick and needy, to keep employees safe, and to work hard to preserve jobs and protect livelihoods.

The explosion of telehealth has been a major byproduct of the pandemic. What can you share about your plans around ongoing reimbursement for these services as well as experiences with your own Doctor on Demand program?

I’ve long hoped that virtual care would become more of a mainstream option for care delivery, but would not have wanted that transformation to be fueled by a pandemic. In 2019, we paid about 65,000 telehealth claims, and through the first three quarters of 2020, we saw more than 2 million telehealth claims.  Patient response to no-cost access for services offered by Doctor On Demand was tremendous.  We will continue offering expanded virtual care benefits for members and pay parity with in-person visits for providers into 2021. Before extending the program further out into the future, we first want to assure that telehealth delivers all that patients hope and expect − more convenient, high quality, and over lower cost healthcare. Through telehealth and other improvements that are needed in our industry, we have an opportunity to pivot to value in response to this pandemic. We should not squander that chance.

​Our industry cannot be the barrier to progress.

Some of the current thinking at BC/BS MN involves the idea of the health care ecosystem. Please tell us about this.

While we currently reference our industry as a Healthcare System, I’d prefer that we aspire to be something better. Let me call it a Wellcare Ecosystem.  What if our industry truly lived the expression “an ounce of prevention is worth a pound of cure?” What if we rewarded prevention, avoidance, social health, mental health, wellness,  eliminating systemic racism − everything we can argue is in the “ounce?”

Similar to a rainforest, health care has a complex ecosystem with interdependent stakeholders that don’t all need to work in lockstep at the same time. Healthcare stakeholders need to be aligned around the same goals and incentives, with everything focused on delivering better care at a lower cost for patients and better health for our community. I believe our current system is unsustainable if left on its current course. The fewer that can afford health care, the fewer in our community that benefit. The more that industry stakeholders work in opposition, the more patients are caught in the middle. My hope is that a transition to an ecosystem centered on wellness will put our industry back on track.

Many people say the employer-sponsored health insurance model is unsustainable. What evolution do you see in this field?

I’m a strong advocate for universal coverage, and believe that all Minnesotans should have access to high quality, affordable healthcare.  To achieve this goal, and to preserve consumer choice, I’m hoping that we can adopt a “no wrong door” approach that offers high-value care options for all that want and need it. 180 million Americans are insured by employer-sponsored coverage today. While that amount may erode over time, many employers enjoy this model and view it as a key tool in attracting and retaining top talent. That said, the primary reason employer-sponsored health insurance is unsustainable is the rising cost of care. As such, I envision that we will see employers become more aggressive in working with plans and providers to use price transparency, innovation, technology, virtual care, selective networks, and other means to improve quality and drive down costs.

Another problem involves hospital costs. How will the role of the hospital change, both in the metro and outstate?

From the start of the pandemic, we have witnessed the critical role that hospitals play in providing emergent and intensive care.  Post-pandemic, I predict we will see the role of hospitals in our ecosystem continue to change. As the population ages, there will be increasing demand for complex and emergent care and appropriate elective inpatient care. In the future, hospitals will likely address this growing demand not through additional bed capacity, but by safely and effectively shifting lower acuity, non-emergent, non-intensive care delivery to other venues, such as ASCs, doctor offices, patient homes and telehealth.  As we have seen at Blue Cross via our growing partnerships with North, Allina, Mayo, Minnesota Oncology, Minnesota Healthcare Network and others, I envision that high-performing hospitals will increasingly become population health companies − with an intensified focus on ambulatory, social and behavioral health as a complement to inpatient care.

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What work is BC/BS MN undertaking to address cultural diversity and systemic racism?

One of the challenges in our industry is we’ve been asked to − or forced to − stay in our lanes. As I mentioned previously, I believe systemic racism and cultural bias is part of the “ounce of prevention.” If we are to play a role in transforming healthcare, organizations like Blue Cross and Blue Shield of Minnesota need to be more than just a claims company, a sickness management company, and a payment company.  Given that our strategic plan is all about reinventing our industry by reinventing ourselves, we are undertaking a bold and comprehensive portfolio of racial and health equity and diversity equity and inclusion efforts.  In doing so, we are getting into the equity business, social determinants of health business, and racial justice business. While I don’t have the space here to add all that we’re doing, I’d be happy to fully share all that we’re doing for those that are interested. Needless to say, we aren’t being shy, remaining silent, or avoiding risks in this space. We are taking bold action to advance true racial and health equity for our team, for those that we serve, and for our community at large.

You have said that the biggest problem facing health care is the resistance to change. What can you tell us about this?

My hope is that all that we’ve been through in 2020 will lead to a fundamental reinvention of our industry. How is it possible that we can cost so much as an industry and yet preserve the gaps we’ve seen  through this crisis? I’m referring to coverage gaps, care delivery gaps, equity gaps and others. If we come out of this crisis and see premiums rise, ongoing inequities, worsening coverage, or a return to a fee-for-service payment chassis, that would only compound the tragedy.  Our industry cannot be the barrier to progress. We must be the drivers of reinvention of our own industry.

Another concept you have put forth is the idea of becoming the “un-health plan”. What does this mean?

At a recent meeting, I heard someone appropriately point out that “if the healthcare industry doesn’t propose change, change will likely be imposed.”  I’ve long advocated for reinvention of our industry from the inside-out rather than awaiting disruptive innovators or regulations driving change from the outside-in.  For me, reinvention isn’t incremental change. It requires transformation. So becoming an un-health plan isn’t about becoming modestly better. It’s about leading a paradigm shift that drives material improvement in patient satisfaction, access, quality and affordability.

Are there any final thoughts you would like to share with physicians as we move into 2021?

In addition to my heartfelt thanks and gratitude, I wish our physician colleagues much health, safety, rest and healing heading into the New Year.

Craig Samitt, MD, MBA is the President and CEO of Blue Cross Blue Shield of MInnesota. Since 2018 he has been responsible for overseeing the strategy and operations of the state’s first and largest health plan.