Council News

September 25, 2023

Health Plans Receptive, But Not Ready for Change

Health Plans Receptive, But Not Ready for Change
by Jacqueline Fellows | Jul 09, 2013


In an interview, Clay Phillips, director of provider relations and communications for Blue Cross Blue Shield of Tennessee,  acknowledges that the nation’s healthcare system “is simply unsustainable in its current course,” and discusses some of the challenges payers are facing. 

The city of Nashville has long been associated with healthcare. In 1995, the city’s chamber of commerce developed the Nashville Health Care Council to help bring together stakeholders in the healthcare and business industries.

Over the years, the council has hosted high profile speakers and workshops for health leaders. It recently finished its most ambitious venture to date, the Nashville Health Care Council Fellows, a diverse group of 33 healthcare professionals representing payers, providers, government, technology, the pharmaceutical industry, and healthcare finance. The Fellows met for eight one-day sessions over four months in Nashville to discuss and learn about healthcare strategies and challenges. 

Clay Phillips, director of provider relations and communications for Blue Cross Blue Shield of Tennessee and a Nashville Health Care Council Fellow recently spoke with HealthLeaders Media about the experience. 

HLM: What did you get out of the experience?

Phillips: There was reconfirmation that the system is simply unsustainable in its current course. They brought a lot of information to bear, both with the payer and the provider, to illustrate that the industry is not going to last long term. We can’t survive at 18% of GDP with poor outcomes. That’s not a provider-bashing comment; it’s simply a fact at this point.

The other thing I got out of it is there are things you can do-big things and things you can do on the edges-both of which matter because the system did not get into the condition that it’s in overnight, and it’s going to take time to turn the ship.

I came away more encouraged that we can do things within the provider community to soften the soil-from changing the way we pay to changing the way we measure how the system functions.

HLM: What were your expectations?

Phillips: My hope was that we could do two things. One, that we could have an atmosphere where the payer, provider, and financing structure of healthcare could come together to have an open dialogue without looking at each other like we have fangs, and they (Nashville Health Care Council) did that. The other thing I hoped to get out of it was learning new things that are coming down the path that can be game changers for the entire market.

HLM: What are those game changing elements?

Phillips: There are technology [examples] that can disrupt our market and force change. A specific example of that are the technologies that are available to monitor conditions in a completely mobile space. You can essentially use a sensor and deploy a network of other sensors to read conditions.

In-home care could be completely altered in the next five years, or how that technology can be distributed in a telehealth network that can completely change the face of primary care. Things like that have a way of forcing the market to wake up because they are game changers.

HLM: Changing how care is delivered will mean a change in how insurance companies pay for that care. How receptive is your industry to embracing these sorts of new technologies that can force that change?

Phillips: I think the industry is very receptive. The pressure to change is on us too, and not just on the premium side of the equation. The challenge is that the payer system is slower to change in some ways than the provider community.

You’re talking about massive organizations that have heavy information technology infrastructures that are hard to move on a dime. Our challenge will be to keep pace and improve scalability and return on investment as fast as possible. So, I think the industry is receptive; I don’t think the industry is prepared for it.

HLM: At some point, the health insurance industry will have to react, what do you think has to happen to catalyze their response?

Phillips: This is a particular challenge for Blue plans. We have to get into a posture where we can pilot quickly and fail quickly. We also have to be willing to come back around when we see modifications developed in the market that we can redeploy if they didn’t work the first time.

A good example of that is disease management. We’ve had some effect on controlling costs, but not the effect that we wanted. If we tie disease management to the technology that was talked about, then we have another way of monitoring and engaging with the patient where we might actually be able to change the cost curve.

It would be incumbent upon the payer community to say, ‘I know the investment in disease management didn’t go so well, but we may have been in that space before we had the capability to move the needle,’ and telehealth is another example of that.

HLM: Is BCBS TN’s partnership with MissionPoint ACO, which has reported some early success with telehealth initiatives in rural areas, helping posture the company to make inroads on disease management and telehealth?

Phillips: Yes. We have to reformulate the way we think about things, and that’s a good example of choosing a partner who can pivot quicker than we can. Our claims systems, [and] our payments systems are not necessarily designed to do that.

HLM: Does the culture of the health insurance industry also have to change in order to respond more quickly?

Phillips: Absolutely. Changing the culture has to happen. One of the speakers, Brad Perkins, MD, (Chief Transformation Officer/Executive Vice President of Strategy and Innovation) from Vanguard Health, approached the issue with what he called the Turkey Fable. The turkey is moving along, getting fattened up and happy, but unless the turkey convinces people he doesn’t need to be on the Thanksgiving table, then he’s got a problem.

All of it ultimately comes down to changing culture. That [story] illustrates one of the great benefits of the Nashville Health Care Council Fellows program. It’s creating an atmosphere where you are not only forced to look at each other across the table, but also recognize that you bleed the same kind of blood they do.

HLM: What kind of work did you do with your healthcare industry peers?

Phillips: They would take us through case studies. They gave us homework assignments to read and we would have to be prepared to defend your concept or recommendations. We went through accounting exercises, and we also had to be prepared to defend the posture of our accounting mechanisms. When you critique case studies in a microscopic way, it forces you to think more like an academic and less like a business person.

HLM: Was your mind changed at all about anything?

Phillips: I became more of a believer in the distinct possibility of having the market disrupted. The market seems so entrenched in so many ways and it is hard to fathom a complete change, but look at the housing market. It’s completely different after the collapse a few years ago, and so are the financing instruments behind it. So, when you look at it from that perspective, you can begin to see the healthcare industry differently.

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