Dr. Craig Samitt, CEO of Blue Cross and Blue Shield of Minnesota, discusses the 2019 World Health Care Congress.
Some of the most influential leaders from healthcare organizations and agencies across the country have convened this week at the 16th annual World Health Care Congress in Washington, D.C.
Among the executives from payer, provider, pharmaceutical, and governmental organizations is Craig Samitt, MD, MBA, CEO of Blue Cross and Blue Shield of Minnesota, who participated Monday morning in a keynote discussion on innovation in value-based care.
Samitt, a longtime WHCC attendee, told HealthLeaders the annual event has served as a "mixed blessing" for him as it provides hope that progress on necessary change is being made, albeit incrementally.
"If the incumbents don't find a way to reinvent healthcare from the inside out, someone's going to come along and reinvent us from the outside in," Samitt said. "It's either going to be Medicare-for-All or it's going to be folks like Amazon, Google or Walmart. They look at healthcare and say, 'You can't get out of your own way, service can be better, quality can always be stronger, and it costs way too much.' I leave these meetings more impatient than I was before."
Samitt said that during his panel talk, there was a shared anxiety among attendees that the healthcare industry "keeps admiring our problems, and not necessarily fixing them." He cited a lack substantial action being taken quickly enough, especially in the push from the traditional fee-for-service model to value-based care.
Given his prior involvement with the Medicare Payment Advisory Commission (MedPAC), Samitt urged a faster move towards "true accountable care" while adding that many organizations that refer to themselves as accountable care organizations (ACO) may not actually be ACOs.
"Just because you take a small upside-only value-based payment doesn't make you an ACO," Samitt said. "Unless you're in the top quintile of quality, while also being there for cost, you don't get to count yourself as an ACO. Our payments have to be more forceful, more risk-based, both upside and downside. Because in my experience, that is the path to true, relentless evolution or transformation."
Samitt said the Minnesota healthcare market is in a position to be an "innovative leader" when it comes to transforming healthcare, specifically regarding care delivery models.
He pointed to the entrance of corporate disruptors to healthcare as an opportunity for leaders to learn from the outside and move towards improving patient satisfaction and driving down costs, all while still delivering high quality products.
Samitt cited Netflix is an ideal example of a company that matured from primarily supply chain operations to delivering content, a transition he says that BCBS Minnesota could play in the future.
"I wonder in a state like Minnesota, with an organization like BCBS, whether we should get into the content business, so to speak, maybe we should get into the care delivery," Samitt said. "If the systems are using excuses and not changing fast enough to accept risk or to evolve their clinical models, then let's be like Netflix, get into the supply chain, and step out of our traditional lane."
Samitt said that in addition to the entrance of corporate disruptors, another trend on BCBS' radar is the widespread proliferation of M&A activity, though he expressed some skepticism of its effectiveness, saying that "getting bigger isn't going to be getting better."
He said the consolidation has led to greater scale for healthcare organizations but has not resulted in greater efficiencies, further complicating an already fragmented industry.
However, Samitt said that he sees this an an opportunity for BCBS to make a move towards care delivery and act as a disruptive player on the provider side
One other trend he's keeping an eye on are the social determinants of health, adding that healthcare has not fully realized the promise of the phrase "a pound of prevention is worth a pound of cure."
"If we start putting in tens of millions of dollars and generate $160 million for every $10 million we invest in the health inequities and social determinants, then all of a sudden we're going to see the potential power of being in the business of profitability of wellness, not the profitability of sickness," Samitt said.
“I leave these meetings more impatient than I was before.”
Craig Samitt, MD, MBA
Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.
Photo credit: ST. PAUL, MN/USA - NOVEMBER 18, 2018: Blue Cross BlueShield Minnesota corporate entrance and logo. Blue Cross Blue Shield Association is a federation United States health insurance organizations. - Image / Editorial credit: Ken Wolter / Shutterstock.com
Samitt said BCBS Minnesota is looking at moving into the care delivery business.
He also praised corporate disruptors for potentially bringing transformational change to the industry.
"If the incumbents don't find a way to reinvent healthcare from the inside out, someone's going to come along and reinvent us from the outside in," Samitt said.