'Our approach has yielded meaningful change': Outgoing BCBS Massachusetts CEO reflects on tenure

Outgoing Blue Cross Blue Shield of Massachusetts President and CEO Andrew Dreyfus said he hopes his legacy is "demonstrating that when people of goodwill come together, extraordinary things can happen."

At the end of December, Mr. Dreyfus is stepping down from the role he has had since 2010. He recently spoke with Becker's about his tenure, the challenges facing the insurance industry and the advice he plans to give to his successor, Sarah Iselin.

Note: This interview was lightly edited for length and clarity.

Question: What is the biggest change you have seen in the health insurance industry since the start of your career?

Andrew Dreyfus: There have been many, but I'll name a few:

  • First would be coverage reform. Our universal coverage law passed here in Massachusetts in 2006 and eventually became the model for the Affordable Care Act, which expanded and improved coverage for millions of Americans.
  • Value-based payments have had a similar trajectory and impact. At BCBSMA, we started our global payment model in 2009, shifting away from fee-for-service payments towards population models that reward performance on cost and quality. Since then, we've seen wide adoption of value-based models across the country.
  • Health equity and mental health are both finally (and appropriately) taking a central place in the healthcare ecosystem.
  • There have been significant structural changes as well — health insurers and healthcare delivery systems have dramatically consolidated. At the same time, Fortune 50 companies have expanded their reach into all aspects of healthcare. And digital companies are disrupting healthcare at every level.

Q: What is your proudest accomplishment during your tenure as CEO?

AD: I am incredibly proud of so many things our company has accomplished. Our involvement in and commitment to universal coverage, our leadership on payment reform, mental health, palliative care and health equity, to name a few.

I am proud we have built a company culture that prioritizes diversity, equity and inclusion in our entire business and workforce. Our approach has yielded meaningful change. For example, the majority of our senior leadership and board are women or people of color. We also have a model supplier diversity program: We insist our consultants — from law firms to auditors and investment advisers — have both a strong DEI commitment and put diverse experts on the teams they assign to us.

I hope my real legacy is demonstrating that when people of goodwill come together, extraordinary things can happen. The common thread through so many of our accomplishments — both at Blue Cross and across the wider healthcare community in Massachusetts — is a spirit of radical collaboration. We recognized that when we bring together diverse groups of people — payers, hospitals, employers, labor, government, consumer advocates and community organizations — with a set of shared goals and values, we can help solve some of the biggest challenges in healthcare.

Q: BCBS of Massachusetts has taken on a number of health equity initiatives. Why is health equity an important focus for the organization?

AD: We have lived for too long with health disparities and racism in American healthcare. Health equity today, in the wake of COVID and George Floyd’s murder, is a vital issue for all of us. And frankly, it's because most of our work to date has failed. If you go back and reread the Institute of Medicine's seminal report Unequal Treatment from 2003, well, it sounds a lot like the conversations we're having now.

So we're upping the ante. From our foundation's giving to our health justice programs and the way we invest in and support startups helmed by entrepreneurs of color, we're accelerating and expanding our work on health equity. But perhaps the biggest change will come from a new program that builds on our payment reform advances over the last decade. We're investing in collecting high quality race and ethnicity data on our members, supporting our health systems with $25 million in grants to help them advance their work on health equity. And starting in January, we'll be the first health plan in the country to create payment contracts rewarding clinicians for eliminating racial and ethnic inequities in care, with a goal of improving healthcare for all 2.9 million of our members.

Q: What is the biggest challenge facing the health insurance industry right now?

AD: Affordability. We do not have an affordable healthcare system today, and we need to change that. Families and businesses struggle to pay their healthcare costs in a fragile economy with inflation at a 40-year high. And at the same time, those same pressures — inflation, demands for higher wages, steeper cost of capital — are putting great strains on our physician practices and hospital systems. In response, these systems are pressuring us and other health plans for unprecedented large price increases.

We recognize hospitals are in a difficult situation coming out of COVID. But there has to be a balance and recognition that employers and employees who are paying the cost of healthcare are facing their own pressures. I don't think it's an intractable problem — Massachusetts has a long and powerful history of solving problems collaboratively. And that is certainly true in healthcare.

Q: What is one piece of advice you plan to share with your successor? 

AD: Sarah Iselin is one of the most talented people with whom I've ever worked. She cares deeply about healthcare affordability, quality and equity, and about the healthcare experience our members have both with us and in the healthcare system more broadly. My only advice to anyone seeking to improve healthcare is to listen to consumers, patients and caregivers. Healthcare is complicated, fragmented, highly regulated and political. But at its core, it's about caring for people at their most vulnerable, their most mortal. It's important to remember that the reason our work matters, the reason we are all here, is we are trying to help ease suffering and promote better health.

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