Business Excellence Awards 2018
Excellence at an enterprise company: Blue Cross & Blue Shield of Rhode Island
Blue Cross & Blue Shield of Rhode Island, a leading health insurance provider for nearly 80 years, is looking to the lessons of the past, as well as the opportunities of the future, to serve its nearly 400,000 members.
Take, for instance, the way the company is bucking the trend of online everything, instead opening brick-and-mortar stores in East Providence, Lincoln and Warwick. At Your Blue Stores, members speak in person with representatives about their plans, their care choices and even get advice from an on-site nurse. Community rooms offer places for members to meet for free exercise or well-being classes, including caregiver support groups. Since 2014, Rhode Islanders have made nearly 60,000 visits to these locations.
“We’re making investments in our communities in meaningful ways,” said Melissa Cummings, chief customer officer for Blue Cross. “We’re in the business of providing for the health and well-being of Rhode Island.”
As such, customization is a key part of Blue Cross’ strategy to encourage customers to gain the most value they can for the money spent.
“The reality of the personalization of the stores is it is keeping pace with what we are able to do in our own lives,” she said. “We personalize everything. Insurance has to keep pace.”
New opportunities include accessibility to a podcast – the “Rhode to Health” – that explains complex health care issues for customers and highlights beneficial community partners.
Blue Cross also aims to give patients all the information they need to make informed decisions, including the recent LGBTQ Safe Zone program that identifies health care practices providing safe, affirming and inclusive care to the LGBTQ community.
“Insurance is looking to help patients differentiate between excellent and average health care,” said Dr. Matt Collins, vice president of clinical integration.
With the Affordable Care Act encouraging more individual plan choices and employers to offer the health plans, the need has never been greater. Blue Cross aims to show businesses how to grow and thrive by attracting talent, offering wellness incentives and using data-driven tools to provide choices and control costs.
“The ACA opened up the market and necessitated moving from business to business, to business to consumer,” said Cummings. “It presents an important opportunity. There are changes in the consumption of health care when you, the consumer, are accountable for the costs.”
The company leads by example. After watching its employee health care costs rise 56 percent in the early 2000s, leadership examined its own plan sustainability and reversed the cost trend by 20 percent.
As a result, in 2017 Blue Cross contributed $23 million into reserves to pay future claims, although the single greatest factor was a one-time investment gain of $10 million. From 2013 to 2017, the insurer says it averaged approximately $21 million a year in operating gain but $23 million a year in overall net loss.
Many new efficiencies come from a more patient-centered system and advanced primary care, linking patient care providers together virtually, or in a coordinated environment, with oversight from a primary care doctor.
“The more contact with the primary care doctor, the better the quality of care and the lower the cost,” explained Collins, adding that Blue Cross is also helping members find affordable medication and manage treatment.
“Medications do no good if you’re not taking them,” said Collins.
Behavioral health is getting more attention, with Blue Cross encouraging doctors to screen patients at regular exams for behavioral health, substance abuse and depression, among other indicators. The company has removed the prior-approval requirement for in-network mental health or substance-use disorder services and lowered the copayment for outpatient office visits.
Health insurance offers a set of benefits and a network of physicians, Collins explained. “Now we customize and personalize those options to get individuals and employees to use them.”
