Photo: Dr. John Espinola, Executive Vice President of Healthcare Services at Premera Blue Cross.
There was a time when conflict between doctors and insurance companies was a normal and accepted part of the healthcare business, but that's changing. It's becoming increasingly apparent that strong relationships are critical and are often the key driver of people getting better care at a lower cost. This was a recurring theme expressed by the keynote speakers and panelists at the 2018 Washington State of Reform Healthcare Policy Conference last week in SeaTac. The all-day event featured healthcare industry experts and policy-makers from all over the state.
The need to forge solid relationships with medical providers is not a new concept to Premera, a point strongly reinforced during the Executive Keynote session featuring Polyclinic Chief Executive Officer Lloyd David, Hall-Render Managing Partner Tom Donahue and Premera Executive Vice President Dr. John Espinola.
Espinola, who practiced geriatric medicine for more than a decade before joining Premera, attributed Premera's long history of successful partnerships with providers to the many physicians and medical professionals employed at Premera. We bring our own experience and understanding of how healthcare works and are keenly aware of the challenges that providers face every day,” he said.
Espinola shared what he thinks are critical elements for making provider and insurer partnerships work:
- Trust: There will inevitably be disagreements.
- Alignment: Ensure both parties agree on the path to the end goal.
- Persistence: Healthcare is complex and a change in course may be needed.
- Fearlessness: Don't be afraid to try new things to help the partnership endure over time.
“It's not about us; it's about our customers,” Espinola explained. “It's about what's happening to our customers at the point of care, which is why we can only succeed by working with and through providers.
In a separate session, Beth Johnson, Senior Vice President of Premera's Healthcare Services Division, joined Vision Source Chief Medical Officer Paul Williams and Moss Adams Partner Karl Rebay. In their session, they each shared their perspective on future payment trends between insurers and medical providers. Johnson highlighted Premera's increased use of value-based care arrangements.
“For decades, insurers have paid doctors and hospitals for each individual test, procedure and treatment they provided, an arrangement that continues to drive up healthcare costs," Johnson explained. “Under a value-based healthcare arrangement, they are paid based on quality patient outcomes, coordinated care, and appropriate costs,” she said.
Premera has been a major sponsor of State of Reform Health Policy Conference since it began in 2010. The Washington conference is the state's largest gathering of healthcare leaders and brings together industry experts and state policy makers for a productive conversation about the opportunities and challenges facing our healthcare system today.
Melanie Coon is a Senior Communications Manager at Premera and leads external communication strategies toward promoting and protecting Premera's brand and reputation.