The Check Up: Kim Keck of the Blue Cross Blue Shield Association

Kim Keck, president and CEO of the Blue Cross Blue Shield Association, talks about some of the ways insurers can address community needs.

You started Jan. 4. What have these first few months been like for you, especially coming from a state-based Blues plan to now working with 36 nationwide?

I had the privilege of running a state (plan) and understanding how Blue Cross Blue Shield plans operate. … I truly believe that we’re markedly different in our connectivity to a community. I often said in Rhode Island that community service was in our DNA. And I believe that is the case for all Blue plans.

I came into this office just as the COVID-19 vaccination process was beginning for the country. So one of the things that we did early on as Blue plans (was) initiate something called Vaccine Community Connectors—there’s that word again, community—to help ensure that vaccines were equitably distributed, particularly to socially vulnerable seniors. We partnered with (America’s Health Insurance Plans) on this work. I had a goal probably starting in February of this year to get 2 million shots in the arms of socially vulnerable seniors. And now we’re moving beyond that. So coming into the new role in the middle of the pandemic, I got to stress that community connection.

With so much attention on the pandemic, have you been able to focus on any of the other organizational priorities?

It’s interesting because last summer Blue Cross Blue Shield plans across the country took a pledge to make meaningful change on health disparities. This was following the George Floyd murder in the spring of 2020. And then in the fall of 2020, we approved at the board of directors, a national health equity strategy. So a part of what I came in to do is in fact, make that national health equity strategy a reality. The two are obviously connected … because we know that COVID-19 exacerbated long-standing health disparities and to deadly proportions.

We know that Black Americans are dying from COVID-19 at a rate one-and-a-half times greater than white Americans. We know Native Americans are dying at twice the rate of white Americans from COVID-19. We also know we have a Black maternal crisis in this country where Black women are dying from pregnancy-related complications at a rate three times that of white American women.

How are you going to measure success of the maternal health efforts? The data will take time to catch up to what you’re doing.

The goal is to reduce maternal health disparities by 50% over five years. And in some respects we have got to shine a spotlight on this now because this crisis is long-standing.

To your question on measurement, this isn’t a one-dimensional issue. It certainly won’t have a one-dimensional solution. One of the measures we’re looking at is what’s called SMM—the severe maternal morbidity index—(which) measures among other things, complication rates, unexpected outcomes and delivery. We will certainly be using others (and) working with national experts to measure the success.

How else do you see payers pivoting to address structural racism and health equity?

The national health equity strategy is absolutely aligned to do that, but I think there are plenty of examples on which we can build in the Blue system as payers. And I don’t think we are just payers, back to my opening statement about Blues plans (being) community oriented. The combination of our role as a payer and our role as a community leader really come together on creating an equitable system of health and one that serves all populations. One example would be CareFirst where we have had a maternal health program underway for almost a decade. And we’ve seen infant mortality decrease by 30%. This is how we integrate into the community. This is about having community health workers literally go door to door into the homes of vulnerable moms, working with them on things like nutrition and prenatal care. Do you have a safe place to live? It’s also coming back repeatedly up to the second birthday of the child. There are many other examples.

In Rhode Island, a couple of years ago we launched something called the Rhode Island Life Index, which (looked at) the connectivity to the community in terms of the needs that get in the way of someone’s health and well-being. If someone doesn’t live in a safe community or have access to transportation or secure, affordable housing, they can’t really have a healthy outcome.

With the Rhode Island Life Index, we partnered with policymakers, community leaders and not-for-profit organizations to really understand the data and to drive different outcomes to say, “We want to collectively make a difference, not just again how we pay for healthcare, but how we think about achieving overall health and well-being.”

Can you talk about how the relationship between payers and providers can and should evolve post pandemic?

We’ve been having these conversations for some period of time, but certainly the conversations are picking up and it’s a welcome event. The pandemic did have some needed and innovative approaches to how care was delivered … telehealth of course, some digital disease management. But one of the things we know, and I think this is something we absolutely have to leverage or build upon, is the fact that providers who relied on value-based payment arrangements during the pandemic fared better than those who did not.

When the pandemic first came and we all were asked to stay home, we know there were no services and in a fee-for-service model, when there were no services, there are no fees. But it turns out, not surprisingly that providers who relied on value were a better suited, not just from a financial stability and resiliency perspective, but even from the perspective of coordinating care. As we think about Blue Cross Blue Shield membership, we have about 67 million members tied to some form of value. So that’s a great number. We serve 110 million. About 50% of our costs are tied to some level of value.

I’m a big believer in primary care, even potential budgeted or capitated models. In Rhode Island, we had great success working with primary care, thinking about how to spend more in primary care, even given a fixed budget, (which) might have been 10% of overall cost, for example, spent on primary care versus a state average of 6% to 7%. But to do so in a way that actually got at the high cost issues that sometimes are preventable.

There are great examples to build from. North Carolina is one I often cite because Blue Premier started by Blue Cross Blue Shield of North Carolina a couple of years had about $150 million of savings and better quality. So these models can work and we’ll continue to push them through the next phase as we work our way through this pandemic.