Five Questions With: Mark Waggoner

Mark Waggoner, a senior vice president at Blue Cross & Blue Shield of Rhode Island, expects  a new affiliation with Integra Community Care Network to make health care more accessible. / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND
Mark Waggoner, a senior vice president at Blue Cross & Blue Shield of Rhode Island, expects a new affiliation with Integra Community Care Network to make health care more accessible. / COURTESY BLUE CROSS & BLUE SHIELD OF RHODE ISLAND

Mark Waggoner is senior vice president, care integration and management for Blue Cross & Blue Shield of Rhode Island. Waggoner spoke with Providence Business News to explain the recent affiliation between BCBSRI and Integra Community Care Network, a partnership of several physician groups that is designed to make health care more accessible and affordable.

PBN: Explain which organizations comprise Integra Community Care Network LLC, and what is the goal of this affiliation between Blue Cross & Blue Shield of Rhode Island and Integra?
WAGGONER:
Together, BCBSRI and Integra are focusing on proactively managing patient health needs, with an eye toward making care more accessible and affordable.
Integra is the partnership of Care New England Health System and its network physicians, Rhode Island Primary Care Physicians Corp., and South County Health and its network physicians.

PBN: What cohort of individuals insured by BCBSRI will be eligible to seek care through Integra facilities and what scope of services will be provided there?
WAGGONER:
Approximately 60,000 BCBSRI members with Integra primary care physicians are eligible to access Integra services. The customer-focused services offered by Integra include eight new primary care access centers affiliated with Integra and strategically located across the state; a patient support hub to coordinate all aspects of a patient’s care, such as scheduling specialist visits and providing support in accessing health care resources; and initiatives designed to prevent illness and keep patients as healthy as possible.

PBN: Will additional resources of personnel, equipment or money need to be deployed to the Integra facilities to provide these seven-day-a-week primary care services? Where will those resources come from?
WAGGONER:
The primary care access centers are located at existing primary care sites; we are expanding hours of operation for those locations and welcoming BCBSRI Integra patients who may not normally receive primary care services at such sites.
Together, BCBSRI and Integra are committed to ensuring BCBSRI members receive the right care in the right setting at the right time. Ultimately, with improved access to primary care services, our members will have the option to avoid high cost settings, such as urgent care centers or emergency rooms, when what they really want and need is convenient access to a primary care physician.

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PBN: How do you envision this affiliation between BCBSRI and Integra impacting the demand on local hospitals, including their emergency rooms?
WAGGONER:
There is a very direct connection between more accessible primary care and lessened demand for emergency rooms. BCBSRI always wants our members to seek care at the emergency room when they feel it is necessary, but if programs like this can improve access to primary care and also lower costs to patients by minimizing the use of expensive emergency rooms for standard, non-emergency needs, that is a terrific outcome.

PBN: Have Blue Cross & Blue Shield entities outside of Rhode Island implemented such affiliations, and what has BCBSRI learned from them?
WAGGONER:
What is unique about most Blue Cross plans like BCSBRI is that we are locally based; because of our local roots, Blue Cross plans place a great deal of importance on working very hard to develop relationships with our provider partners throughout the community.
Across the country and here in Rhode Island, we have learned that health care and communities’ needs are truly local, which has allowed plans like BCBSRI to uniquely tailor affiliations – such as this one with Integra – to best meet our members’ needs.

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