Kevin Splaine, recently named executive vice president of care integration and management at Blue Cross & Blue Shield of Rhode Island, is now leading the network management, pharmacy and care integration teams to drive BCBSRI’s efforts to make health care more affordable for Rhode Islanders. A health care executive with nearly 25 years of experience working with hospitals and health systems, Splaine will also focus on partnering with providers to transform delivery systems while advancing quality of care, utilization management, pharmacy operations and clinical initiatives.
Providence Business News asked Splaine how he hopes to lower health care costs and his opinion of the task ahead of him in the Ocean State.
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PBN: Your mission is to make health care more affordable for Rhode Islanders. What’s the first thing on your list of steps to make that happen?
SPLAINE: There is an old industry adage that “all health care is local.” I truly believe this. Health care affordability is an imperative at all levels in our society (state, federal, economy, business, family, individual, etc.) and will be driven through a continuation of health care reform.
It is my opinion that the balance of health care reform will take place at the state and regional levels and it will be driven through innovative products, payment mechanisms and partnerships among providers, insurers and purchasers of care.
As a new executive to the state and market, my immediate emphasis will be on understanding the market and establishing relationships to build upon the great work that has already been accomplished and to further shape the future.
PBN: Can you go into detail about your duties as executive vice president of care integration and management?
SPLAINE: I now have the honor of serving with an incredibly talented, multidisciplinary team responsible for provider contracting, care management, utilization management, pharmacy benefit management and a number of other functions that are all focused upon relentlessly ensuring that our members have affordable access to health care at the most joyous and vulnerable points in their life.
A good portion of my career has been as an executive on the delivery system side of health care and it is my intention to bring that lens into how we rethink and reshape how we pay for and provide health care in collaboration with the providers of care across the state.
PBN: Please elaborate on the role population health will play in managing health care costs in the state. Is there something about that the average health care executive doesn’t know?
SPLAINE: I think the average health care executive today is well versed on what population health is and what’s required to make the shift toward bettering the health of a population. The challenge that we face as an industry is that we’ve built the world’s best system of episodic care – when someone is sick, in general, we do a great job of treating them.
Population health requires systems, incentives and investment of resources be aligned to focus not just on the episodic but also on transitions of care, coordination of care, keeping people healthy and proactively managing people’s care and experience. It’s a big shift and I know many health care executives feel that they are standing in side-by-side canoes as they balance the needs of delivering high-quality, safe and effective care while managing a shift in focus to population health.
PBN: Why are innovative and new payment models important in controlling health care costs?
SPLAINE: As an industry, health care is in its infancy of competing like almost every other industry in our global economy – offering a product that is centered around its customer, is highly reliable in its safety and quality, has a positively differentiated experience, is at the lowest possible cost and continuously improves on all of these fronts as the basis of competition.
We have made great strides in adopting payment models that are increasing the emphasis on delivering high-quality, cost-effective care and less on the more that is done. The continued evolution of payments that reward value and realign incentives to allow the investment of resources to be made to not just be paid for value but compete on value will be one of the driving forces leading to greater affordability.
PBN: What is it about the health care delivery system that needs to change?
SPLAINE: I wouldn’t limit the question to the delivery system. Health care is a complex ecosystem of providers, insurers, patients, purchasers, regulators and more. As a nation, we started health care reform in earnest and as imperfect as the start has been, it requires far more reform and change.
I firmly believe the solutions for true health care reform will happen at the state and regional level and will require all of us as leaders to effect the change. One of the reasons that I am so excited about moving to Rhode Island is that there is an opportunity to effect change that is not easily matched elsewhere given the size of the state and the proactive and progressive history of solving complex problems.
Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.
