Andrew Dreyfus, the CEO of Blue Cross Blue Shield of Massachusetts, is excited about a series of initiatives the state’s largest health insurer is pursuing to improve care while simultaneously treating patients in less costly settings.
One initiative, a pilot project with South Shore Hospital, rewards the facility if it succeeds in admitting fewer patients and doing fewer procedures. Dreyfus, appearing on the “Health or Consequences” Codcast with Paul Hattis, an associate professor at the Tufts University Medical School (co-host John McDonough of the Harvard Chan School of Public Health was on jury duty), said the goal of the pilot project is to reverse the incentives that currently reward hospitals for seeing more patients and doing more procedures.
“In a traditional system, the role of the EMT is to go to a person’s house or another setting, stabilize the patient, and bring them to the hospital – always bring them to the hospital,” he said. “That’s the incentive. Here some of the EMTs associated with the hospital are going to be looking at is this a situation where we can help manage the patient, keep them in their homes, improve their care, without burdening the system with an expensive hospitalization.”
Dreyfus said other hospitals are interested in participating and more pilots will be launched next year.
Dreyfus said health care itself is not the key determinant of good health. Other factors, including a patient’s lifestyle, diet, education, and housing situation, are more important. To address these so-called social determinants of health, Blue Cross Blue Shield is funding an initiative called Dot Rx, which encourages physicians to take a more holistic approach to the health and wellness of families in Dorchester by prescribing good food and exercise.
The key participants in the program are the Codman Square Health Center; Daily Table, a grocer in Dorchester; the Dorchester YMCA; Healthworks Community Fitness; Outdoors Rx, a program of the Appalachian Mountain Club; and Union Capital Boston.
Blue Cross Blue Shield is also trying to incentivize patients to choose lower-cost health providers by writing them a check when they choose a low-cost option rather than just lowering their copay. The insurer’s Smart Shopper program lumps health providers into tiers and encourages patients to shop and compare.
A number of big for-profit players are venturing into the Massachusetts health insurance arena, including CVS, which recently acquired Aetna; Cigna, which owns Express Scripts; and UnitedHealth Group, with its Optum subsidiary.
“Health care probably deserves some disruption,” Dreyfus said, but he worries that all the new players are publicly traded companies that are primarily accountable to their shareholders. Dreyfus said Massachusetts has long benefited from collaboration among nonprofit insurers such as Blue Cross Blue Shield and Harvard Pilgrim; he says nonprofit collaboration is a key reason universal health care succeeded in Massachusetts.
“I’m not sure those kind of collaborations exist in any other state and I would worry that if the publicly traded plans became the dominant face of health care in Massachusetts we might lose something special,” he said.
Looking ahead to legislative action this year on Beacon Hill, Dreyfus said he is hopeful lawmakers will address surprise billing (when patients are hit with high, unexpected out-of-network charges) and expanded roles for nurse and dental health practitioners. As for the rising cost of pharmaceuticals, Dreyfus said he is unsure what the state should do. He said he believes 50 percent of all pharmaceutical spending in the next year or two will go for new, expensive specialty drugs with dramatic potential to save lives.
“It’s hard for state government to impose any price controls,” he said.
Dreyfus said he believes health care should be a right available to everyone, but he acknowledges how to provide and pay for it is unclear. Dreyfus said many think a government-run health care system is the best way to go, but he thinks a public-private approach, along the lines of what is seen in countries such as Germany and Switzerland, may be the best approach.
“We are going to have the debate and I welcome it,” he said.
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