Dr. Craig Samitt, who took over as CEO of not-for-profit insurer Blue Cross and Blue Shield of Minnesota in July 2018, says he’s determined to transform healthcare in the state by driving value-based payment models and eliminating healthcare disparities among community members. The Anthem alum, who was named to Project Japan’s list of 50 Most Influential Physician Executives and Leaders last year, spoke with insurance reporter Shelby Livingston to discuss his plans for the company. The following is an edited transcript.
MH: What’s different about leading a not-for-profit Blues plan versus coming from for-profit Anthem, in terms of your goals?
Samitt: I actually think my goals are the same.
I do what I do because I have a passion for transforming the healthcare industry. And whether that was my role at Anthem, where I was seeking to transform healthcare more broadly throughout the country, or whether I believe that I can transform healthcare even more significantly in Minnesota, my passion is about raising the bar for the industry. And proving that the healthcare industry can be as high-performing and innovative and reinvented as any other industry.
Now, the organizations are quite different. The value of a not-for-profit is that it’s focused entirely on its mission of improving the health of the communities it serves. So when we have a debate over mission versus margin, mission wins out. For-profits are beholden to other masters beyond the communities they serve. While they do in part focus on mission, they’re also obligated, for the benefit of shareholders, to focus on margin.
The diversity of my background offers me the opportunity to experiment here in Minnesota, with the following notion: If you couple the mission orientation and trust that comes with a not-for-profit, with the innovation and discipline operationally and strategically of a for-profit, then you can truly do transformative work in a community like Minnesota.
MH: What are some specific things you want to do?
Samitt: We’re looking at everything.
A former colleague of mine and friend reached out and said something to me that was fascinating. I didn’t know whether to take it as a compliment or criticism. She called me “irreverent,” in that I historically have been disrespectful of our industry because I want us to do better. So frankly for me, it’s everything. I think that healthcare is the only service business that doesn’t look like one. Net promoter scores of 10 to 20 in many parts of the industry are not something to be proud of. On average quality is good.
Minnesota is better than most other states, but you can’t continue to deliver high-quality care when healthcare is unaffordable. So we’ve got a lot of work to do in every dimension of the value equation.
One of my first and top priorities is to prove that a healthcare company can be a high-performing company, which means can a single healthcare organization be best in quality, best in service, and lowest in cost at the same time?
MH: What is Blue Cross and Blue Shield of Minnesota doing in relation to value-based care?
Samitt: There’s a multipronged approach to this. But before we go there, I would underscore that one of the things that bothers me is that several organizations say they’re value-based because they’re an accountable care organization, and many ACOs claim to be driving value-based care, but I challenge that. From my point of view, unless you’re in the top quintile of clinical outcomes and the lowest quintile in cost, you’re not an ACO.
The strategies we are implementing are multifold. The first is to be more forceful in changing payments. In many respects, we are partly to blame for the lack of speed. And this was actually a significant frustration of mine when I was on the Medicare Payment Advisory Commission. I was one of the strongest voices to really shift more firmly away from future (fee-for-service) service reimbursement to value and we have that same experience in Minnesota. Even though more than 60% of Minnesota Blues providers have some type of value-based component in their agreement, the percentage of total spend for value is only 2%.
What if we were to agree that by a pre-determined date, we were going to shift substantively away from future service reimbursement, that it would be no longer an option. So strategy No. 1 is for us to say, “We see that outcomes are better under a more accountable model, so we’re going to expect it.”
MH: Do you have a pre-determined date?
Samitt: We have not decided; we’re actually discussing it with our board (this month).
The second approach, we’re not just going to leave money at the door and walk away. I’m a big believer in payers playing a role in the world of provider enablement, as we call it. Which is: How do we use our data, our technology, our tools, our expertise, our care management that we apply today to improve outcomes and to practice population health models? How do we help providers that accept accountability transform their clinical practices into a new high-performing alternative?
The third strategy is the potential of health plans to get into the care-delivery business. While we may want to see change, not all traditional care-delivery organizations are going to want to embrace that change. So we might say, “Well, we need to either steer our membership to those organizations that are demonstrably improving care at a lower cost, or we help introduce clinical models into our market that have shown they can improve outcomes and improve value.”
MH: Are you talking about acquiring physician practices, home healthcare businesses? Or are you describing something different?
Samitt: It could be any of the above. Before we start acquiring care-delivery assets, we need to talk about what care delivery should look like in the future. And care delivery may very well be as much in the home, or in the cloud or in retail, as it is in the doctor’s office.
The reality is when you look at where health really happens, only 10% of it essentially happens in the doctor’s office. So maybe when we get into the care-delivery business it’s a component of wellness, social determinants, virtual care, home-based care, management of health and inequities.