'One of the challenges is ubiquity': How CareFirst's CEO is driving local healthcare on the national stage

Brian Pieninck has led CareFirst BlueCross BlueShield as president and CEO for nearly six years, and he was recently elected as chair of the Blue Cross and Blue Shield Association's board of directors.

Mr. Pieninck sat down with Becker's to discuss one challenge the healthcare industry faces today: ubiquity. With his dual role serving 3.5 million members in the Mid-Atlantic region and now 120 million at the national level, he shared how Blue Cross Blue Shield is finding the right balance between local community change and a broader effort to move all of healthcare forward.

Listen to the full conversation with Mr. Pieninck on the "Becker's Payer Issues Podcast" here.

Question: You chair a board of directors that influences the healthcare of 1 in 3 Americans. How are you addressing social determinants of health at CareFirst, and how are you now promoting that across diverse populations nationally?

Brian Pieninck: Our mindset as an industry on this topic really needs to shift. Social determinants are known, they're measurable and they are most certainly actionable. And really this is about our community — where we're born, raised, live, take care of others — all the factors and forces that exist around us and affect our health. Eighty percent of our health is informed by these social environmental circumstances, and not just currently. That is the health trajectory for our future in terms of our needs and quality of life. 

So we've got to shift the narrative that these things are not intractable or immovable, but an opportunity to think differently from an investment perspective and bring action to this. One of the things that attracted me to CareFirst and to Blue Cross Blue Shield nationally is the opportunity we have in local communities, because we are a part of every local community in the country. We're the only collection of companies in the healthcare system that serves every single county. It's an incredibly powerful thing to be a part of and an amazing responsibility. We're looking way upstream into the root cause of what impacts health and health trajectories. 

Q: Can you share some details about local CareFirst initiatives, such as the D.C. Health Equity Fund and the West Baltimore Workforce Development Program?

BP: The West Baltimore Workforce Development Program grew from a conversation that we started around serving the community. Originally, CareFirst was looking to make investments in historically underserved and disinvested parts of Baltimore. When we went to the community, we found what they wanted most of all was career opportunities, the ability to participate more consistently in our economy, and to think about how wealth building could impact not just personal lives, but also collectively. We went back to the drawing board, and over a two-year period we built out a plan in partnership with other organizations to develop a workforce development program that was delivered and launched last year. We graduated 100% of our first cohort, we just welcomed our second, and we are en route to expanding this at scale to about 100 employees for each career path designated for the West Baltimore community. This is a great example of leveraging not just philanthropy and volunteerism, but really our corporate infrastructure to impact and change the trajectory of a community. 

We've also partnered with the Bowser administration in Washington, D.C., and the Greater Washington Community Foundation to launch a $95 million health equity fund that is directed toward systemic long-term impact. This is an unprecedented amount of money that's being directed toward these types of investments, and we're talking investments that can produce a generational return. A few rounds of funding grants have been approved, and we have engaged outside organizations to study the near- and long-term impact on the community. These programs are each tailored to the reality of the locale and the people that we serve, and I think that's what makes them most impactful.

Q: How do you see these initiatives being scaled or adapted to benefit a broader national audience? 

BP: We have to be really discerning when we have this conversation about making local investments and the degree to which they can and should be scaled. One of the challenges we've had in healthcare generally is ubiquity. We try to roll out big programs that are scalable, and then we try to ensure that those programs reach the reality of individual lives. Sometimes you can do that and it's incredibly effective, and sometimes you have to meet people where they are and really carefully consider the life that you're trying to affect and the circumstances in which that life exists.

I do think that there are many transferable lessons though. We recognize that there's an inextricable link between physical infrastructure and the reality of healthcare outcomes. We should be thinking about healthcare as jobs, education, transportation, housing and food security, all of which influence and impact the human condition. 

Q: How can local and national policies and strategies facilitate these local and regional health initiatives?

BP: One of the most important things we can do is leverage what we've learned and really assess the causal relationship between what we've invested and the impact and outcomes that are produced. That level of rigor and real consideration for the data that we collect, and how we measure and manage these programs, is critically important to helping inform other programs and the degree to which those programs can be grown and scaled. We have to enter into this world with the same kind of discipline that we apply to the core of our business. When we think of these things as philanthropy or charity, oftentimes we don't approach them with the same kind of planning, intentionality and rigor in terms of execution. We've really been deliberate about ensuring that we invest and execute at a level that's consistent with how we run the core of the organization. That's a critical part of taking the work that we do and bringing it to policymakers to participate in conversations about how we can adjust policy for broader and more compelling impact. 

Q: What trends are you watching now that you anticipate will most significantly impact the future of healthcare in the U.S.? 

BP: There's a few trends that all of us as healthcare leaders are tuned into and should continue to tune into:

The U.S. has an aging population. As the population ages, it increases the downward pressure not just on healthcare infrastructure that is already strained, but on the economy as a whole. Questions of access and affordability will become more challenging to address — not easier — if we don't innovate, invest in and reconsider our current structure. 

Health equity. This absolutely has to be at the core of every conversation that we're having. The data is indisputable that we've had an inequitable healthcare system for quite some time, though the pandemic has helped to illuminate that reality. I'm optimistic that more people are contributing to an expectation that we actually address the root cause of issues to deliver a more equitable healthcare outcome and experience to each person that participates in the system. 

Pharmacy costs are out of control. They are on a trajectory that desperately needs to be addressed. The only way to do that effectively is to thoughtfully consider this issue from a public policy perspective and through private sector interventions to ensure that we absolutely can deliver life improving and altering medications and solutions to people, but in a way that is sustainable economically. 

The dichotomy that is emerging technology. It is absolutely critical that we are capable of thoughtfully leveraging technological advancements to address not just quality and outcomes in healthcare, but also efficiencies in our ability to deliver that care at a price that each of us individually and collectively can afford. We really need to be careful that we don't take the shortcomings of healthcare and codify them into technological solutions that can be delivered at a faster pace and with broader application. We've got an incredible responsibility to ensure the benefits of technology and use of technology in the industry at this moment in time, even more so than in the past. And with that is a degree of humility about ensuring that we don't allow for unintended consequences to be realized.

Q: Final thoughts?

BP: It can feel daunting at times with the number of things that we're confronting in healthcare, but in the midst of that is incredible opportunity. I would continue to encourage leaders to lean in with an open mind, a degree of humility and a willingness to collaborate. If we do that, and we do that consistently, I think the path forward will be there. 

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