Bertolini says he is a believer in creative destruction theory. “Health insurers need to move beyond the traditional role of adjudicating claims to a role that is more relevant and suited to the expertise we can contribute,” he says. “Our new delivery models with some of the top healthcare providers across the country reorient the health system from volume to value and measure success by improved patient health.”
The results, he says, are not only better quality and lower costs for patients, but also more fulfilling work for providers.
Patricia Hemingway Hall, president and CEO of Health Care Service Corp. (which includes Blues plans for Illinois, New Mexico, Oklahoma and Texas) also notes that a new role for payers is emerging.
“This is an exciting time of great transformation and never-before-seen levels of collaboration between the health insurance industry and providers of care,” Hemingway Hall said in an e-mail. “People are beginning to see us more as contributors to healthcare rather than the old perception that we were controlling healthcare.”
HCSC has worked with Boeing Co. to embed nurses in medical groups to provide coordinated care. It has partnered with Advocate Physician Partners in Downers Grove, Ill., to create the largest accountable care organization that participated in Modern Healthcare's annual ACO survey, with 4,100 doctors providing care for about 553,000 patients.
Hemingway Hall, No. 23 on this year's 100 Most Influential roster, says HCSC is also committed to competing in health insurance marketplaces in every county of every state they do business.
“This is an opportunity to provide coverage to those who until now have not had insurance, allowing us the ability to connect with these individuals and expand our relationships,” she says. “This is both a business strategy and another way that we stay true to the purpose of our company.”
Follow Andis Robeznieks on Twitter: @MHARobeznieks