Martha L. Wofford, Blue Cross & Blue Shield of Rhode Island’s CEO and president, has been at the insurer’s helm since March. Selected for the role after a national search, Wofford came to Rhode Island from Colorado, where she was group vice president of a network of kidney dialysis centers.
Wofford, a veteran business and health care administrator, shares some of her immediate goals and discusses Blue Cross’ dual Medicare/Medicaid coverage.
PBN: You come to Rhode Island with years of varied experience in leadership and health care. How will your background serve you in your new role as the head of BCBSRI?
WOFFORD: My experiences on both the payer and provider sides of health care give me real-world perspective on the challenges each face in helping people access affordable, high-quality care that is designed to keep them healthy. My experience at national companies where you have broad scale but diffuse populations also gives me incredible optimism about the opportunity we have in a small, densely populated state to come together to address the challenges locally.
It is far easier to help providers shift from a traditional approach that pays them each time a patient receives care to one that rewards them for keeping people healthy and out of the hospital, in a smaller geography.
Lastly, I “grew up” in public service and feel passionately about making the health care system work better for people and communities and addressing the disparities that get in the way of optimal health.
PBN: Have you had a chance to identify any goals that you are looking forward to working on?
WOFFORD: Yes! In addition to accelerating the shift to value-based care, or “well care,” with sustainable provider arrangements, we are focused on making care more convenient for our members.
Our four Your Blue Store locations, in Warwick, Cranston, East Providence and Lincoln, are a great example of making it easier for members to address a whole range of needs, such as getting benefit questions answered in English, Spanish and Portuguese, meeting with a nurse, enjoying a yoga class, taking a cooking class, etc.
We are continuing to advance our digital tools to provide convenient access to help, including behavioral health and other telemedicine visits. Ultimately, we want to advance care models that provide personalized, convenient care for individuals and provide high-quality, affordable, whole customer care to companies.
In addition to convenience, we are working to champion comprehensive health and well-being for all Rhode Islanders. This involves expanding our presence in government programs to serve the whole population and to advance health equity. From our vantage point, health equity involves measuring and then acting in collaboration with the community. We are focused on measuring preventive care by race, ethnicity and language to ensure that all populations have access to high-quality care.
To measure and address the broader issues that prevent people from living healthy lives, we partner with the Brown University School of Public Health on the RI Life Index, a tool that tells us how Rhode Islanders perceive access to social determinants of health, like access to healthy food and affordable housing, as well as health care. What we have clearly heard is that safe, affordable housing remains our greatest challenge, which has guided our philanthropy. We’ve made grants of $3 million during the past three years to safe and affordable housing.
PBN: What were some of the factors behind BCBSRI’s recent decision to offer dual plans for members who are eligible for both Medicare and Medicaid?
WOFFORD: We believe all Rhode Islanders deserve affordable, quality coverage. About 38,000 Rhode Islanders fall into the historically underserved population qualifying for both Medicare and Medicaid. Most live in our core cities of Providence, Pawtucket, Central Falls and Woonsocket, where more than 25% of children live below the poverty level. Many face barriers to care, like cost, transportation and language. Our dual special needs plan addresses these barriers in partnership with community-based organizations, delivering specific benefits and greater support.
PBN: BCBSRI’s 2022 Medicare Advantage health maintenance organization and preferred provider organization plans recently earned five-star ratings from the Centers for Medicare & Medicaid Services. What does that mean for members covered by these plans?
WOFFORD: Members enrolled in five-star plans experience lower out-of-pocket costs, high member satisfaction, better health outcomes and a best-in-class provider network. We are extremely proud of the five-star designation given by our members and CMS. It is a testament to the great service our employees provide and the great care the providers we work with throughout the state deliver. Achieving five-star demonstrates that we truly understand and meet the needs of the more than 60,000 Medicare Advantage members we serve.
PBN: Is there anything new that BCBSRI is doing to address health equity?
WOFFORD: Yes. In addition to our ongoing focus on housing, we are committed to addressing significant inequities around maternal health, especially for BIPOC [Black, Indigenous and people of color] Rhode Islanders. The 2021 Rhode Island Kids Count Fact Book listed a 30%-40% gap between BIPOC and white Rhode Islanders. Adverse events are 63% higher for Black women and 32% higher for Latinx women.
Armed with this data, we supported the passage of the doula bill in the Rhode Island General Assembly, and we are now preparing to implement our own doula benefit for commercial members on Jan. 1, 2022. We’re working with the existing doula community to boost the qualified doula workforce in Rhode Island, ensuring that resources are there for training and certification. And we are forging new partnerships with providers around maternal health management, which must be viewed through an equity lens.
Access to behavioral health providers and creation of programs for people with substance use disorders are also health equity priorities for us. And to support Rhode Islanders experiencing food insecurity and isolation during the pandemic, we began a program of grocery delivery to our most vulnerable members.
Health is much more than health care. The pandemic exacerbated and shined a light on long-standing health equity issues. As we determine how the state will spend more than $1 billion in ARPA [American Rescue Plan Act] dollars, we have a once-in-a-generation opportunity to invest in the health of all Rhode Islanders. At BCBSRI, we are honored to work with the community to build a more equitable system together.
Elizabeth Graham is a PBN contributing writer.
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