Editor's Note: Originally published in the
27, 2017 edition of The Herald
Let me introduce you to a novel
idea for the healthcare industry: put the customer first.
When I became
the CEO for Premera Blue Cross three years ago, I made putting the customer at
the center of everything that we do our guiding principle.
It sounds so
simple, doesn't it? After all, this is what great brands like Amazon,
Nordstrom, Alaska Airlines, and Microsoft do every day. Yet, somewhere between
the family doctor pictured in those iconic Norman Rockwell paintings of the
1940s and 1950s and season 5 of Grey's Anatomy we in the healthcare industry
to some degree lost our way.
Health insurance companies occupy a
unique position within the healthcare system. We serve as a connection
between the patient and the doctor and their pharmacy. Our position as the
“payer” affords us a global view into healthcare.
The result is we
spend a lot of time listening to people talk about their healthcare
experiences. What they tell us can be broken into four common concerns:
Spend time digging
among the many reasons why our current healthcare system is broken and you
quickly discover they stem from an outdated “fee for service” model in
healthcare that rewards doctors for the volume of care they deliver rather than
the quality of care.
As a health plan, we are partly to blame for
enabling this practice to continue for so long. We paid doctors to run more
tests, make more appointments, and prescribe more pills, but we didn't reward
them for making you well.
This is by no means an indictment of doctors.
Regardless of the method of payment, the vast majority of doctors do great
work. They care deeply about their patients and strive to give them the best
care possible. However, in a system that rewards volume, many patients undergo
expensive tests they don't need or invasive procedures that put them at risk.
In some cases, the cure really is worse than the disease.
I can hear
the critics now: as a health plan, your job is to pay the bills and make sure
my doctor is in network. Fair enough. But at Premera, we believe that if we
are truly to stand beside our customers, we need to do much more than pay the
bills. We need to work with doctors, hospitals, and government to make
healthcare work better.
The Everett Clinic is a great example. Back in
2012, they became one of the first medical clinics in the state to sign a new
contract with us that included specific quality benchmarks to ensure
patients received the best care possible. The Everett Clinic received
financial incentives based not on the volume of tests and procedures, but on
keeping patients healthy. Since then, we have signed similar agreements
with nearly every major clinic and hospital system in the state.
healthcare is to work better then we all need to think differently about how
care is delivered and paid for. In my industry, we have been brought up to
think that bigger is better, especially when it comes to the size of our
I like to think of it like cable TV. Wouldn't it be great if
you just paid only for the channels you wanted to watch?
Plans for consumers in King, Pierce, and Snohomish counties are designed to
provide the highest quality care at more affordable rates. They include only
doctors and specialists from select medical groups like UW Physicians and The
Everett Clinic. Doctors work as a team to ensure that each patient's needs are
addressed quickly and effectively.
We believe this model, known as
“accountable care,” represents the future of the industry and a path toward
sustainable, stable, affordable care for all.
Of course, these new
models of care don't work if there is no individual health insurance market.
to the Affordable Care Act must address these core principles: provide
affordable and quality healthcare coverage for as many people as possible,
provide adequate funding for Medicaid and provide strong incentives to
encourage people to sign up for coverage and stay covered.
should be to improve the quality of care, while making it more affordable.
Fixing our broken healthcare system doesn't have to be political. But it
does have to put the patient first.
Jeff Roe is the President and
Chief Executive Officer of Premera Blue Cross. Read more about Jeff on our executive