BCBS MN CEO: Rethinking the Role of the Payer

Craig Samitt, MD, MBA analyzes the turbulence of 2020, the lingering challenges facing healthcare, and what opportunities are available for forward-thinking executives in 2021.

After a raucous 2020 upended by the COVID-19 pandemic, healthcare executives are aiming to rebound with a strategic, financial, and clinical point of view in 2021.

Craig Samitt, MD, MBA, president and CEO of Blue Cross Blue Shield of Minnesota (BCBS MN), tells HealthLeaders that he has "mixed emotions about the future" as the industry begins to emerge from the pandemic.

He notes that the latest surge affecting the Gopher State is as bad, if not worse, than the original outbreak last spring, with COVID-19 cases, hospitalizations, and deaths all reaching record highs. In a conversation with HealthLeaders, Samitt describes the coronavirus as a danger that is "real and present," but he also outlines different aspects of the healthcare landscape that make him "optimistic" about rethinking the role of payers.

Below are highlights from Samitt's reflections on 2020 and his predictions for 2021.

'My greatest worry is that we go back to the way things were'

Samitt says that there are questions about what elements of the healthcare system stay and which ones leave in a post-pandemic world. 

One of the "fundamental changes" that he hopes will stick around are more closely aligned value-based partnerships between payers and providers, especially in areas related to social determinants of health (SDOH) and behavioral health.

"My greatest worry is that we go back to the way things were," he said. "We've been calling it the 'Day After Tomorrow' strategy; that what happens in June can't be what it looked like a year ago. It just can't. We have to leapfrog over tomorrow and go to the day after tomorrow and be somewhat insistent and brave. It's not a 'new normal,' I hate that expression. A 'better future' is the way that I would describe it."

Samitt says that BCBS has many levers in play as it works to advance value-based care in the healthcare industry and feels an "obligation" to bring along many other organizations during the shift.

Related: Women in Healthcare Leadership Spotlight: Dr. Penny Wheeler, CEO of Allina Health

Other changes that he hopes will remain are more accessible care delivery models, like telehealth services and home-based care. He adds that there has been "great receptivity," by both providers and patients, to change during the pandemic.

"The silver lining in the midst of the crisis is that I hope that we've all seen the real challenges and inadequacies of our healthcare system as we know it," Samitt says. "I've long predicted that something would disrupt healthcare; COVID didn't break our system because so much was already broken in our industry. We either didn't recognize it or we weren't rewarded to fix it. So, I'm hoping that we've seen the amplification of the challenges of a system that is addicted to volume... and when that volume doesn't occur, whether that is due to a pandemic or, frankly, due to wellness, which is the better alternative, the system can't unravel, as the hospitals have experienced."

Promoting value and addressing racism

Samitt says that payers have historically felt obligated to "stay in our lane" but notes that the pandemic has introduced the idea that "maybe health plans can be successful in the care delivery business." 

In the summer of 2019, BCBS MN stepped into the provider space by securing a minority stake in 20 primary care and specialty clinics that are under the majority ownership of North Memorial Health, a two-hospital system based in Minnesota.

In addition, he highlights the work that BCBS MN has done to address SDOH and racial health inequities, especially considering the killing of George Floyd in Minneapolis, which set off nationwide protests against racism and police brutality last summer.

Related: Hospital Groups Speak Out About George Floyd Killing, Nationwide Protests

"I think that our urgency and the opportunities to move faster and further in value has only increased as a result of the pandemic," Samitt says. "We don't have to look far to see the significant, lasting, damaging, and heartbreaking impact that the crisis has had on disadvantaged communities."

Samitt says there are "numerous reasons" for health disparities faced by communities of color, specifically pointing out that healthcare is "inequitable,” and that people of color have faced a disproportionate impact from the COVID-19 crisis.

"The issue we have here is an equity problem, and I want to tie racism to that as well, because racism, from our point of view, is a public health emergency," Samitt says. "Racism leads to inequity, and I think the reason why that is, is that we often use the adage that 'an ounce of prevention is worth a pound of care.' The reality is that's not how the healthcare industry has historically worked. We've been in the sickness business, but if we were to invest in the ounce, I would argue that racial injustice, social disparity, SDOH, along with any of the other things that we would do to prevent, protect, and avoid illness would make us a healthier society."

He adds that BCBS MN has looked beyond its role in the health insurance business, arguing that it should also be in the business of addressing housing stability, food, security, primary care access, and loneliness.

‘We, as the incumbent…have failed the industry’

Samitt says that it is crucial for BCBS MN and other healthcare organizations to not ignore the red flags that have emerged from the pandemic and revert to the standard operating procedures of yesterday. He says that this applies both from a clinical care perspective but also from a racial injustice perspective, too. 

Looking to the year ahead, Samitt offers advice for healthcare leaders.

"I have long wanted our industry to reinvent itself from the inside out and I have long believed that the primary stakeholders in our industry—doctors, hospitals, and payers—have always had the opportunity to create a better model that serves patients in a more high-quality, efficient, patient-centric, equitable way," Samitt says. "We, as the incumbent, so to speak, have failed the industry. I would say that models, as we've established with our partnership with Allina and others, demonstrate that we can come together and reinvent healthcare from the inside out, as opposed to waiting for something else disruptive like a pandemic to change us from the outside in."