With an unprecedented level of focus not only on the social determinants of health (SDOH), but also on the broader societal issues around healthcare and around health, leaders from all sectors of U.S. healthcare are making moves to incorporate such considerations into their strategic planning.
One organization that is doing so is Blue Cross and Blue Shield of Minnesota, based in the Minneapolis suburb of Eagan. There, president and CEO Craig Samitt, M.D., who came to the health plan two years ago this week, and who had spent ten years in clinical practice as an internal medicine physician before working in the health insurance sector, is spearheading efforts to incorporate social and social justice considerations into BCBSMN’s entire frame around care management and collaboration with hospitals and medical groups.
Recently, Dr. Samitt sat down to speak with Healthcare Innovation Editor-in-Chief Mark Hagland to share his perspectives on this important issue. Below are excerpts from that interview.
How do you frame social issues, in the context of your organization’s overall strategic planning, going forward?
When we talked about the gender services consultant role, I had mentioned that the intent of positions like that is really focused on ensuring that Minnesotans have access to high-quality, patient-centric, affordable healthcare. And that is very much the foundational focus of our strategy to reinvent healthcare. And it’s important to remember that COVID-19 didn’t break our healthcare system; nor did the surge of racial injustice; we had a broken healthcare system before.
You are pioneering and forward-thinking in leading your organization forward. But after all, health plans, like all other organizations, have business requirements they have to fulfill. Have you experienced any pushback on this?
There has been pushback against reinvention of the healthcare industry, because there’s a lot within the status quo of our industry that folks are incented to protect. If we look at the desire to change and reinvent healthcare, and we think of it rationally, the first thing that comes to mind is that if we were to start with a white page, would we create the model of healthcare that exists today, in terms of financing and care delivery? We keep adding new wings onto an old, broken-down house. And if our goal is high-quality, patient-centric, affordable healthcare for all Minnesotans, we have to rethink our model. And wouldn’t it be great if we could focus on wellness and not sickness? In other areas of life, we avoid fire risk, legal risk, military risk, through upstream thinking and thinking about prevention. We even say an ounce of prevention is worth a pound of cure. But that is not how the healthcare industry functions. So from my point of view, even before we get to racial injustice, when we think about health inequity, that is one of the foundational drivers of the poor health of many communities here in Minnesota. And the stats are very telling, because on average, we are a very high-quality healthcare state, though a higher-cost one.
But if you actually double-click and look under the covers, we have some of the greatest health disparities in the nation [in Minnesota]. And shouldn’t the first course of business be for every Minnesotan to have access to high-quality care? And when we think of the drivers of health inequities, it is very hard to separate that from racial justice issues and racial inequities. When homelessness, when food insecurity, when discrimination, when loneliness, all drive poor health—we know very well that if we were to change the situation around racial injustice, it would improve the health of community.
That’s why racial injustice is so important to address. And if you think of this in terms of clinical issues, per COVID-19, it is the marginalized and disadvantaged communities that are facing the greatest risks. And those more likely to have untreated diabetes, hypertension, or pulmonary disease, are likely to be communities of color. So if we don’t address racial injustice and social inequities—all of those things …..
Where is the line between addressing racial inequities and racial justice and actually becoming a social service agency?
I very much believe that the lines are blurring in healthcare. One of the reasons our industry has so much room for improvement is that we’ve all stayed in our corners—health plans, providers, social service agencies. And where things have really advanced is areas in which those lines have blurred. What if all four of those groups—providers, payers, social service agencies, and whole communities themselves—were actually incented to improve the overall health of communities? Incentives would become aligned.
And if we believe as a health plan that there’s a better way to provide care to patients, and it will be telehealth-enabled and in the home—what’s to stop health plans from delivering care? In a world where patients are very reticent to use the traditional system—someone needs to disrupt and come up with a better model. The better way is for us to work in partnership with providers to reinvent themselves—for us to work with providers, with patients, and with social service agencies. So I think the all-for-one-and-one-for-all model is going to be much more effective than any sort of replacement model.
What would you like to say to hospital, medical group, and health system senior leaders about all of this?
One thing I would say is that population health rights a lot of what is wrong; and working together to shift to a lower-cost model would be more effective than continuing with a high-cost, more-care model. Second, we have the opportunity to reshape healthcare from the inside out; and if we don’t do it, someone else will. And if we don’t recognize that a more-care model is not best; if we don’t recognize that health is health is health, be it behavioral or any type of care; if we don’t pivot to a prevention-rich, service-rich model, others will come in and disintermediate the more-care model.
And data will have to help drive this transformational work, correct?
Yes, even as we look at the COVID pandemic, imagine if we had more complete information about communities, about test results, about contact exposure, I think that the resolution of the pandemic would have been accelerated. The same is true of data in healthcare in general, and digital health. We sit with pockets of data that don’t talk to one another, and the reality is that the patient suffers, because we can’t find all the relevant information about optimal care in one place. And what other industry can’t find a way to make change? Here’s another old adage: where there’s a will, there’s a way. I think when it comes to more powerfully using data to change healthcare, data will definitely help provide that way, going forward.