Dana Erickson has been president and CEO of Blue Cross and Blue Shield of Minnesota since October 2021. She sat down with Becker's to discuss the latest trends across the health insurance industry and what her company is doing to lower care costs, drive health equity and navigate the healthcare landscape in a post-pandemic world.
Covering more than 2.5 million lives, BCBS Minnesota is the state's largest nonprofit health plan. Ms. Erickson joined the company in 2015, bringing with her a background in clinical and medical leadership. A nurse and respiratory therapist by training, she has direct experience in home-based and rehabilitative care.
Question: What do you believe is the most important insurance trend that executives should be keeping an eye on?
Dana Erickson: Affordability of care and the rising cost of healthcare. This is not a new problem, but I think with the pandemic and certainly a lot of the focus on talent departures within the industry, that will have an impact on costs. It is still the issue that we hear about from purchasers, whether that is directly from members to employers, agents and brokers. Ultimately, if we cannot provide access to care because of the cost, it doesn't matter how innovative and how personalized it is.
Q: Insurance executives often cite the lack of robust data-sharing between payers and providers as the biggest challenge they see facing the implementation of value-based payment models. How can the industry better facilitate data interoperability within the context of alternative payments?
DE: We view it as truly joint accountability for these models to be successful. Obviously, the providers are really leaning in on looking at their care models and how to be more focused on outcomes, but we also need to be present and help them, which is where data is key.
Everyone is worried about protecting data these days, but there are ways that we are doing that with our providers that are in value-based arrangements. We're also focused on making sure that the data we give is actionable. We have large integrated systems here in Minnesota and we give them a lot of data — but are we providing it in a way that's really actionable for them down at the level of the clinicians who are on the front line making decisions? Are we identifying those at-risk patients? Seamless data-sharing and making sure we're giving providers the right insights to get to the right patients are the areas that we're focused on. One of the things that I'm very committed to, having been a clinician myself and working in different parts of the healthcare system, is how we can be even more collaborative and a partner with our provider systems to be successful in these evolving models.
Q: Payers across the board believe social determinants of health account for around 80 percent of a patient's care outcomes, and 20 percent is from medical care. What are some recent SDOH investments your organization has made, and what's on the horizon?
DE: We've invested in actually gathering the data. One of the things that has been a challenge is making sure we're incorporating race, ethnicity and language data, which is tough to get. We're looking at how to work together on making sure that we have access to data that can help us better identify those numbers and our population health data and analytics. Another area we're investing in is accessing the data and then utilizing it in our own internal systems to better identify populations that are at higher risk.
Secondarily, you have to actually invest in programs and different ways to interact with members around social determinants of health. We recently invested in the state of Minnesota for providing doulas, who support women during childbirth. We're specifically supporting people moving into the industry that will help support predominantly women of color, as we know that group has poorer health outcomes than the broader maternal population. These are things that we can actually do tangibly in the field to help support people who may otherwise have barriers to accessing the best health outcomes.
Q: Your company launched a digital health equity pilot with three companies in Brooklyn Center this month. How is BCBS Minnesota incorporating health equity initiatives into its business strategy?
DE: COVID-19 illuminated the health inequities that were already here. We were the first organization that came out to say that racism is a public health emergency and being dedicated to that is a part of our strategic plan on equitable care. If it's not equitable, then we don't see it as meeting our mission of helping everyone achieve a healthy life.
We have dedicated investments on an annual basis around what we call place-based partnerships. Brooklyn Center is one of them, where we're at the table. We believe that the answers come predominantly from the community, and we're there to support that. But we need to listen first, so those investments in organizations like TurnSignl and others are a part of that.
We're also investing internally. Like I mentioned before, access to data and the doula program is where we can invest in the actual healthcare system to help drive better outcomes and more culturally competent care. I'm a firm believer that we have to hold a mirror up to ourselves and look at what we are doing internally before we can be credible in the market. We have a diversity, equity and inclusion focus, and one of the things that I'm most proud of being here at Blue Cross nearly eight years now is that this is not new to us. Our foundation, the Center for Prevention, and BCBS have been a presence in the state for many, many years in supporting access to care and really reducing those inequities across the board.
Q: You started your career in nursing and have experience in home-based care. What lessons have you taken with you starting on the provider side and how does that influence where you want to take BCBS in terms of delivering care directly in the home and hospice settings?
DE: It's something that I'm so grateful for now — those experiences both as a registered nurse and respiratory therapist and in public health nursing, which was an eye-opening area. It taught me a few things. One is that we do ultimately have a pretty fragmented system that often misses those 80 percent of things that we experience as a person that impacts our health. That hugely impacts the way I've looked at our role within the larger healthcare ecosystem, and how we help continue to drive care that's more personalized, which predominantly happens in the home.
One of the big trends I see after COVID-19 is the expectation of healthcare consumers to no longer be treated episodically. You're not a heart patient, or a cancer patient — you're a holistic patient that needs and wants care that sees you from all aspects of your life, and much of it happens in the home. As a clinician I would go into people's homes and see the empty refrigerators, I would see equipment that had been purchased that was literally sitting inside bathtubs and never being used, and I would see the rural places where people could never drive and get to a provider. We have to continue to look for solutions and continue partnering. I'm a big believer that there's not any one part of the healthcare system that can solve the issues we're facing, we must do it collectively. We have to help providers with different tools to identify those needs in the home and community to lead to a better outcome.
I try to remember some of those patients I worked with in the community on a day-to-day basis because it helps ground us in our mission at Blue Cross, and what we need to do to continue to build our capabilities and work collectively within the healthcare space to meet people where they are.
Q: The industry is rapidly growing its offerings of Medicare Advantage plans. How do these plans fit into your organization's growth strategy?
DE: Medicare has been an area of growth for us and we have a very strong presence in Medicare generally, and specifically in Medicare Advantage. It is a part of our overall growth strategy and it continues to be an area of focus for us. A huge part of the solution and strategy has to be looking at partnerships in the community and in the home. We're really seeking to identify and help members who are on a trajectory of chronic illness and even into palliative care and hospice.
Q: Every week we see reports of a health system and a major payer severing in-network ties, leaving patients unfairly caught in the middle. Each case is different, but are there better strategies insurers can take to avoid these contract fallouts?
DE: Value-based contracting is one of the best ways to really be thinking longer term. We have the privilege of being a part of a longer-term value-based contract with Allina Health, one of our local, large systems. We were really committed to making that a multiyear strategy, and part of it was to weather what can arise. Right now, that's inflation and the cost of labor. It allows us to look at a longer-term partnership with our providers that seeks to reimburse them for outcomes and allows them to invest in some of the capabilities we talked about. It also gets us out of coming back every one to two years and potentially having this more contentious relationship. That is certainly not our desire because it leads to instability in the market, and most importantly, instability with patients and their outcomes. Our desire is to pay a fair price for healthcare, but we still believe that we need to continue to push toward different and innovative payment models that really seek to eliminate some of the instability that these year-over-year negotiations can drive.
Q: Several BCBS companies have created travel benefits for their members or employees to access reproductive care following the overturning of Roe v. Wade. Is your company considering the same?
DE: First and foremost, access to abortion services and reproductive rights is actually a part of the Minnesota Constitution. We had questions from employers as you can imagine, but our commitment is to follow this state and the constitutional right of women to access those services.
We did include a travel benefit for our employees because we do have employees that live outside of Minnesota and dependents as well. Self-insured employers have the option to do that if they so desire, and we're working with them.
I think that this is one area that's going to be interesting to watch because we think about care as local, but none of us really are fully that anymore. We've become a much more transitory world in many ways. I think that it'll be critical for us from a Blue Cross perspective to work across our association across all of our health plans to make sure that we're following the law, certainly, and that we're also listening to our consumers and making sure people have access to the care that they are entitled to.
Q: Final thoughts?
DE: The system that we have today and the healthcare system that's been created has set up a structure that is unsustainable, and I think we're sort of there. We have to come together across the healthcare ecosystem to align financial and health incentives that can address the cost of care and move care more upstream, which it is really just not designed to do. I'm optimistic about doing that. It's urgent for our industry.