Karen Ignagni is the CEO of New York City-based health insurer EmblemHealth and the former president of AHIP. She spoke with Becker's July 27 about the most pressing issues facing payer executives in 2021.
Editor's note: Interview has been lightly edited for clarity.
Question: What are the biggest questions payer executives are asking themselves at this time?
Karen Ignagni: I think, "Are we doing enough in our communities to advance health equity? To take a strong role and a seat at the table on public health, and to meet members where they are with a variety of different digital tools and service tools?" I think those are the kinds of basic questions. There are exogenous issues with respect to healthcare equity and public health, and it's very important, I think, for leaders to always be asking themselves, "Are we doing enough to contribute to community health?" And also from an inside perspective, with all of the tumultuous events that have occurred over the last 16 months, from a global pandemic to many of the events starting last summer with George Floyd's murder. The entire industry needs to rethink and really commit to a very strong diversity, equity and inclusion agenda. And we've certainly done quite a lot of that ourselves. So that would be the other internal piece too, from a cultural perspective.
Q: What are some of the initiatives EmblemHealth is working on to deal with health equity issues?
KI: A great question. We have made significant investments in our community. We are about coverage, but we are about care, and that has two aspects to it for us. One is we have a network of 40 physician groups, primary and specialty practices located throughout our geographic area. And our physician groups are led by individuals who live in the communities they serve. They look like the communities they serve, and they're very tuned into the social fabric of the communities they serve.
The second part of our agenda on the care side is we have committed to build a network of neighborhood health centers. And we now have 14 located in some of the most underserved areas in New York. And that's a place where the community, whether they're members of our health plan or not, can come in and get help with social determinants of care, get help with transportation, housing. They can take a class. They can get help with health insurance. They can get help with diabetes — very specific care programs that we offer — and use our internet services. So there's a very significant community commitment in our plan beyond the coverage work that we do through the health insurance side.
Q: What are your biggest priorities for EmblemHealth as the industry makes its way out of the pandemic?
KI: No. 1, making sure that we are tuned in to our communities and focused on a very strong community health agenda. That is crucial for us. Second, to make sure that we are playing a role in pushing the envelope with respect to partnerships with providers, whether they be hospitals, physicians, etc., in value-based terms so that we can continue the push toward not only value-based care, but care that is better, more friendly to the individual from the standpoint of their language, friendly to an individual with respect to how they want to receive care, whether it's digital or in person, and friendly to an individual in terms of all of the services and support they may need. So tuning into the spectrum of care from prevention and wellness to care coordination, disease management, and centers of excellence and catastrophic coverage.
Q: What would you say are your biggest challenges at this time?
KI: Most payers would answer that question with one word, and that would be the cost of care — unit cost — and in two areas. One, there's been so much that you all have written in Becker's and other places certainly about the cost of pharmaceuticals. How a new drug is priced, whether it has any relationship to the [research and development] investment that the companies have made. And in general, the answer to that is "no." So how do we, as a society, embrace the concept and make sure that our population has access to the latest developments, but at a cost that's affordable and sustainable. And right now we are tipped in the wrong direction on pharmaceutical costs. The second part of this would be, in my view, hospital unit costs. We work in our tri-state area in very consolidated markets.
And I know that there's a reason that regulators are beginning to ask questions. The attorney general in California sued a very prominent healthcare system. And now that individual is secretary of Health and Human Services. The Biden administration has indicated their interests in what is the impact of consolidation in a variety of industries, and they've indicated they're going to be looking at health. We have some of the highest costs in the nation in New York, which follows very much, I believe, from the consolidation of this market and some of the market practices, which are anti-competitive. So I think that there will be much more focus on unit costs and how do we, from a sustainability perspective, make sure that the population that's being promised access to healthcare, that that promise can be sustained given the levels of costs these days.
The second area beyond cost is the area of social determinants of care. So it's almost in stepping back and enlarging the care aperture and thinking about, how do we look at the whole person? And how do we think about what may impact their ability to access healthcare, their ability to continue to get continuous care and treatment, and how do we help with that? One of the things we did as a health plan last December is we did a national survey, and then did a very close look at our markets where we operate. And we were probing on whether or not people had adequate internet access, adequate devices, because the promise of digital applications is so great, yet we know that there are significant barriers. And so now we are working with city leaders and state leaders to sound the alarm that we shouldn't leave anyone behind. But that's a healthcare issue because as we think about both telehealth, but also think about digital access, it's very important for populations, particularly that have been underserved, that do live in areas where they don't have reliable internet coverage, or don't have enough devices because one device in a home may be being used for school, for work, for social engagement. That is something that I think from the perspective of our society, we have to step back and say, how do we solve those problems? Because that becomes an access-to-healthcare issue, but it's also an equity issue.
Q: What advice do you have for other CEOs?
KI: I think if you are lucky enough, and I feel very lucky, and I do not take it lightly at all to be in a position of a CEO, that there is a responsibility that is quite significant that goes along with that. You have a unique opportunity to address diversity, equity, inclusion. We've done that. We've created a committee with a very diverse group of our associates. We've created a new corporate policy statement. We've started a variety of groups that are grassroots groups of people who want to come together. And we have done quite a lot of leadership training from directors on up to make sure we're being culturally sensitive, focused on creating and sustaining a welcoming culture where people can feel very comfortable, that they can come as they are and be accepted, notwithstanding race, religion, sexual preference, sex, you know, you name it. And I think there are responsibilities that go with leadership positions, and that is a good example of taking the responsibility and being a provocateur for change and for progress. I think that's very important.