As president and CEO of Blue Cross & Blue Shield of Rhode Island, the state’s largest health insurer, Peter Andruszkiewicz is aware that the company often serves as the lightning rod for all the things that are “wrong” with the current health care delivery system.
In the two years since he took the helm in 2011, he has been a strong advocate for health care reform and payment reform. Blue Cross has become a major investor in primary care and the patient-centered medical home model, and created innovative, shared savings contracts with hospitals and physicians’ groups alike. He freely admits there is no silver bullet to correct a fragmented system with perverse incentives.
He spoke with Providence Business News about the challenges facing Rhode Island as it moves to implement health care reform.
PBN: How does Blue Cross view the launch of the R.I. Health Benefits Exchange?
ANDRUSZKIEWICZ: That’s a wide open question. I love that. Because you given me that kind of latitude, I’m going to take it back, one step further,
We need health care reform in Rhode Island – and in the United States. Health care reform, in my mind, can occur only when two things happen, two big structural changes. The mess that we have in health care today, we have created a system that is not really a system at all in Rhode Island.
One is the lack of universal coverage; the second is payment dysfunction, with perverse incentives and payments to providers.
The Accountable Care Act – through Medicaid expansion, through federal subsidies, through the elimination of medical underwriting as we know it now – guarantees universal coverage.
The implementation of the exchange creates a simplified way for consumers and for health plans to bridge from B-to-B business to a B-to-C business.
The exchange if implemented well, and if it achieves its goals, gives me a lot of comfort that we’re addressing that one of the fundamental structural problem with health care, universal coverage.
PBN: And the second fundamental structural problem, payment reform?
ANDRUSZKIEWICZ: The Affordable Care Act tries to address it as well, but it’s not as clear a line to the system solution around payment reform.
The whole notion of the accountable care organization is to change the incentives for providers. We need to. The incentives in the system today are for more business and more fragmentation. That’s where all the incentives are in the system today.
Everything that we’re doing at Blue Cross is focused around collaborating with providers, collaborating with government folks, and with our customers to change those incentives to the thing that we all want – community population health, higher levels of care and quality, and prevention programs.
We want to activate consumers who are well today and to keep them well. If they have chronic diseases, we want to make sure they get the treatment that they need, and that there’s not a financial barrier to do that.
So, the exchange really gets at the universal coverage piece very nicely, I think.
Working along with government and providers, the change in provider incentives is what our work is really about.
PBN: What kinds of new products are you planning to introduce as part of the new health insurance marketplace?
ANDRUSZKIEWICZ: Our new SelectRI plan, which is very similar to the Coastal Medical shared savings contract, was introduced a few months ago, and it is really gaining traction. Some 35 to 40 accounts have chosen it – both small businesses and a couple of large groups.
What you’ll see with these products is that not all customers are choosing it as their total replacement, but they are putting it alongside the plan that they already have.