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Forecasting the Future of Health Care: An Inside Look



Horizon's Chief Strategy Officer Talks About Adapting to COVID-19 and Setting Strategy in a Fast-Changing World

William D. Georges, Senior Vice President & Chief Strategy Officer

As Chief Strategy Officer for Horizon Blue Cross Blue Shield of New Jersey (Horizon BCBSNJ), what lessons did you take away from the COVID-19 crisis? How has the crisis affected the company’s priorities?

Crises often help you see things more clearly, and I think that was the case with COVID-19. Two things stand out for me.

First, it crystalized very quickly and clearly just how critical flexibility and adaptability are to being there for our members when they need us most. With COVID, our members and the employers we serve faced challenges to their health and well-being that were unimaginable just a few months ago. We needed to pivot quickly, working closely with our partners in the health care community to provide access to new services and to make sure those services were affordable. So we did things like waive the out-of-pocket costs for COVID testing and treatment, help members and their employers maintain health coverage and make telemedicine easier to use. COVID reinforced the importance of staying nimble, flexible and member-focused.

Second, COVID put an even brighter light on the racial and ethnic disparities in health care and the need to do more to put mental health on equal footing with physical health.

It’s estimated that African-Americans and Latinos are three times more likely to contract COVID-19 and twice as likely to die from it than white residents. In part, this reflects the fact that minorities are more likely to live in densely populated urban areas and to work in essential, high-risk occupations.

But it also reflects deeper inequities in our health care system: the fact that minority populations have a higher percentage of underlying chronic conditions that put them at greater risk from COVID and that they generally experience worse medical outcomes than white residents.

COVID also triggered a wave of anxiety, depression, stress, substance use disorder, and suicidal thoughts across all corners of the population. We have indisputable evidence that mental and physical health are interdependent. We simply cannot help people achieve their best health unless we are enabling whole-person care – mind and body.

All of this reinforced our belief at Horizon BCBSNJ that we have to approach health care holistically – taking into account not just medical factors, but mental health, Social Determinants of Health (SDOH) - like access to housing, nutritional foods, transportation and other resources that have traditionally been beyond the scope, and reach, of health care.

Thankfully, we launched our Horizon Neighbors in Health program – a concerted effort with seven healthcare delivery partners across the state to address SDOH – at the beginning of this year. That program, which hires and trains local residents to serve as community health workers, proved to be a critical lifeline during the pandemic that connected members with vital services even though they were essentially quarantined.

What are two or three trends that you see impacting the future of health care the most, and what are the major players doing to shape or respond to those trends?

Setting aside COVID for a moment, the most important macro trend we need to tackle continues to be the rate of medical cost inflation, which was outpacing wage growth and GDP growth even before the pandemic. The pandemic’s impact on employment and New Jersey’s economy is only going to make it more critical that we, and I mean all of us who play a role in the healthcare system, come together to flatten the cost curve just like we came together to flatten the COVID curve.

The major drivers of medical cost inflation are specialty drugs and medical technologies. Right now, total cost inflation is 4 to 5 percent. But embedded within that rate is specialty pharma, which is growing between 25 and 35 percent per year. Just by the law of numbers, if that continues to grow at 35 percent every year, at some point it will become large enough to significantly increase the pace at which the overall rate is growing.

The solution to accelerating cost inflation is value-based care, which requires a level of collaboration and commitment to a common good that takes a lot of work and a lot of trust. You can take away big chunks of that inflation by changing the way care is delivered. That’s why we have long championed value-based programs in which we partner with doctors and hospitals to put the focus on building models of care that are focused on the quality, not the quantity, of care delivered. We use quality improvements to drive the total cost of care down and make the experience more convenient and connected for members. As New Jersey’s leading health solutions company, we have an obligation to be a catalyst for those changes and to be on the leading edge of new developments that rein in the cost of care.

Another major trend is consumerism – but a new style of consumerism. Even before COVID, consumers were saying, “Solve my problem in a way that I know what I'm getting. Show me where there is a better quality, lower-cost provider. Help me navigate my cancer care, which is so complicated. Help me get an appointment with a physical therapist after my hip replacement so that I'm not re-admitted to the hospital.”

COVID has added another layer of complexity to this picture. Consumers today need greater transparency and even more support in navigating the health care system. The good news is that much of this is solvable. We’re already delivering some of it with the technology tools we’re giving consumers. But we need to be able to do more.

How has the role of technology changed at Horizon BCBSNJ over the past decade?

There’s been a steady progression of technology over the years, starting with strictly back-office technology that supports the claims process to predictive algorithms that allow us to keep costs low by more accurately predicting health care cost trends and setting pricing.

The next evolution of technology, which COVID is accelerating, is aimed at empowering consumers – helping them derive greater value from their health care. We’re already seeing this in the rise of telehealth triggered by COVID and by the greater use of apps like the Horizon Blue app.

But we’ll soon see powerful new applications that will affect doctors and patients at the point of care delivery – enabling higher quality, more cost-effective care and better member experience. That's really going to change the equation and make health care very different than what we know today.

To fully participate in this next evolution, however, we’ll need to have the right technology infrastructure in place and the ability to invest in and partner with technology companies whose innovations will power the next generation of care.

Community Health Workers (CHWs) in the Horizon Neighbors in Health program, for example, use NowPow, an online platform they access from a tablet they carry with them. NowPow maintains an up-to-date inventory of services available from local social, non-profit and community service organizations and the CHWs can connect members with those services, make appointments or enroll them in programs, while they are sitting with them in their kitchens.

And Horizon BCBSNJ members seeking treatment for opioid addiction rely on technology from WorkItHealth or Eleanor Health to access services virtually, online or via a Web or phone app. Similarly, members in a new Horizon BCBSNJ mental health program access services from AbleTo, a leading provider of telephonic mental health care. All of these Horizon BCBSNJ partners are critical to the care and treatment our members rely on.

How is Horizon BCBSNJ positioned to keep pace in such a fast-changing industry?

Our national, for-profit competitors are investing heavily and experimenting extensively. And because they are so much bigger than we are, they're able to invest more in any given endeavor and invest in more things to see what works.

Some of them are integrating vertically – buying provider systems or pharmacies. Others are building deep analytic capabilities – aggregating datasets and investing in the technology to analyze that data and deliver critical information to health care professionals at the point of care.

Given our competitors’ scale and resources, there's no way we can compete with them on technology alone. We have to pick other focal points where we can competitively differentiate – through affiliations and partnerships working with other “Blues” or investors.

What we do have, of course, is an intense local presence and an unmatched New Jersey focus. We share an interest with our local provider networks in solving the health issues that are right on our doorstep – how to deliver the most affordable, highest quality care for New Jerseyans.

The national health insurers don’t have this same interest. They're solving for one problem only – cost. That’s because they’re more concerned about their shareholders than their members. They don’t care if their member lives in New Jersey or Wisconsin. And they’re less focused on the member’s experience or his or her outcome.

Horizon BCBSNJ is strictly about New Jersey, and we’re the only company that cares about the health and welfare of the people in every single zip code of the state – hence our commitment to programs like Horizon Neighbors in Health. That gives us a unique perspective and, we think, a unique opportunity to help shape the future of affordable, accessible health care here.

Being able to invest in the kinds of partnerships and technologies needed to make health care work the way New Jerseyans want it to work is central to our ability to continue collaborating with our health partners to create that future.

Beyond technology, what other innovations will impact the evolution of health care to improve affordability, quality and/or outcomes?

Everything sits on a backbone of technology, but the next layer on that foundation is how the technology gets used – how it improves the quality of care, makes it more affordable, or delivers a more convenient or simple patient experience. That increasingly comes down to how we use health care data.

There is a ton of data already out there, but it exists in disparate systems. It’s not connected. Some of it is even outside of the traditional health care ecosystem – like data related to a person’s living situation or social support network. We’re looking to bring all that data together and make it part of a predictive algorithm that will help deliver better care. That’s not only a matter of crunching data but making it useful at the point of care – during a doctor or home health visit or even as a person is being wheeled into the emergency room.

Predictive analytics is also closely related to determining quality of care and lowering the cost of care. In fact, we’re working with a Silicon Valley firm now on analytic software that will help us develop more objective measures of quality and potentially reward the highest quality providers. In the end, that allows us to lower costs and deliver better quality care. This is exactly the kind of innovation that we want to be investing in for the benefit of our members.

How will health care look different to patients, providers and health insurers at the start of the NEXT decade?

I'm hopeful that we will have made meaningful advances on many of the things we've talked about – especially around lower cost, customized care. Imagine you wake up one morning not feeling well. You’re at home and a doctor shows up. She has a testing kit and can draw and analyze your blood right there and then deliver the appropriate treatment in response. It will be convenient and cost-effective and medically appropriate because we've done the right analysis and we know that you don't need to sit in a waiting room for four hours and take half a day off from work.

We'll also be able to design and deliver customized and more transparent benefit packages. As a consumer, it will be clear to you what is going to get paid– depending on what doctor or hospital you go to and what care you need. At the employer level, we'll also be able to deliver custom-designed benefits and networks that more closely match the needs of employees.

All these things are going to be enabled by technology and underlying data analytics. And all of it is going to be more cost-effective and just a much more elegant way of delivering health care to our members.