By Harold Ambler
By Harold Ambler
The president and CEO of Blue Cross & Blue Shield of Rhode Island, the largest insurer in the state, Peter Andruskiewicz, has more than 30 years of health insurance expertise, including a background in sales, marketing and general management. Before joining Blue Cross in 2011, Andruskiewicz led operations at Kaiser Foundation Health Plan of Georgia, the state’s largest nonprofit health plan. A native of Salem, Mass., Andruskiewicz lives in Rhode Island with his wife. They have four grown children.
PBN: Your new partnerships with Lifespan and Care New England are focused on lowering costs and improving care. How long have insurers been striving to lower health care costs, and are accountable care agreements the single greatest hope for achieving the goal?
ANDRUSKIEWICZ: Since my first days at BCBSRI, I’ve talked about the need to change our health care system and to do so quickly. Insurers can play a key role in creating incentives for change and encouraging innovation among the provider community.
We need to move to a more rational approach of rewarding providers based on improved patient outcomes, quality, safety and costs, and away from the current model of rewarding the volume of care delivered. We are encouraged to see that Rhode Island’s largest health care providers are now forming systems of care and that these systems are making significant commitments to finding new ways to improve quality and the patient experience, while making care more affordable. We need to do this work with a greater sense of urgency.
Ultimately, we are all pushing toward physician-led, patient-centric systems of care that can also lower costs. From our customers’ standpoint, this work can’t happen fast enough.
PBN: To what extent did being at the helm of BCBSRI during the first year of the Affordable Care Act feel like sailing through stormy seas? Or, to put it another way, how have the seas been since last October?
ANDRUSKIEWICZ: Health care and health insurance has always been a dynamic and challenging space to work but never as challenging as it is today because real change is happening. The good news is that all the players – hospitals, physicians, other care givers, insurers, the state and federal government – are beginning to get on the same page. Rhode Island has been one of the national leaders in planning for expanded access to care and coverage and preparing for the implementation of the Affordable Care Act. We have worked and continue to work collaboratively with state officials to make the ACA work for the people of Rhode Island.
We also put a lot of time and energy into consumer education – including opening a retail location, expanding the ability of our staff to help people understand their options and supporting the state’s efforts to launch HealthSource RI. This is where BCBSRI’s experience in the individual market has been invaluable and allowed us to help residents successfully navigate a new system.
PBN: Are there any stories that you’re hearing about very specific instances of improved care resulting from the accountable care agreement with Care New England and RI Primary Care Physicians?
ANDRUSKIEWICZ: While we haven’t had the systems in place long enough to point to specifics examples, the Care New England/Rhode Island Primary Care agreement announced last month is already creating value in terms of improved communication and a focus on proactively addressing the very specific types of health issues seniors face. Another innovative pilot we are proud of is HealthPath, a behavioral health initiative with Care New England and Continuum Health, a subsidiary of the Providence Center. This pilot provides a new, highly coordinated approach to behavioral health services for commercial members. The program links participants to a comprehensive set of customized, integrated services that include counseling, psychiatry, care coordination, medication management, connections to primary care and wellness programs, as well as vocational support and case management.
PBN: What are the conditions that have cost the most in the past where savings through accountable care may add up the most?
ANDRUSKIEWICZ: It’s not necessarily about a disease state, but rather the way care is delivered in every disease state. Let me explain. It is widely accepted that almost one-third of the spending in the health care system today in Rhode Island, and in the U.S., is waste or unnecessary health care spending. To take waste out of the system and eliminate unnecessary spending, all care givers and the insurers have to be aligned and committed to making hard changes. These changes will be good for quality of care and for costs. These new agreements we’re putting in place provide for this opportunity.
We envision a virtually integrated system of care givers who focus as much on prevention, population health, identifying problems before they become chronic, and keeping people fit and healthy as they do on treating and managing diseases like cancer and heart disease.
PBN: Other insurers are pursuing a private exchange model for small businesses in Rhode Island, and you have indicated that you have plans to do something similar. Do you think it is a good idea for Rhode Island?
ANDRUSKIEWICZ: You bet. Like most health insurers, BCBSRI has long focused on providing employers with a wide variety of products and choices on how to buy products. Now the world is changing and putting choices for health insurance increasingly in the hands of consumers. And just like we have seen in the pension world, employers will begin to migrate to a defined contribution approach to pay for health insurance.
Private exchanges will be one of many options employers will have (along with buying on a group basis as they have done historically or using the public exchanges like HSRI) as they determine the level of involvement they want to continue to have, and are able to have, in paying for health care for their employees.