What 5 physician execs have to say to other MDs seeking payer leadership roles

Becker's recently asked one question to five physician executives who announced plans to take on new payer positions in August: What advice do you have for physicians who are seeking leadership roles at a health insurer?

Here, new physician leaders at Independence Blue Cross, Blue Cross Blue Shield of Massachusetts, MetroPlus Health Plan, Regence BlueCross BlueShield of Oregon and WellCare Health Plans share their advice:

Rodrigo Cerdá, MD, vice president of clinical care transformation at Independence Blue Cross: "Health plans are fortunate to be in a position now to help drive progress for care quality, patient experience, provider experience, and per capita cost, and they need clinicians to help guide those efforts. To better prepare for a leadership position at a health plan, clinicians should expand the usual scope of their continuous learning to incorporate areas of knowledge necessary to influence a health system, including business, economics, public health and behavior change. This can take the form of formal education such as degree programs at schools of public health or business, work experience that can range from medical directorships within their current organizations to involvement with health-focused startups, and independent reading of publications focused on health systems — whether it is the health policy section of their clinical journal or more dedicated publications like Becker's, Health Affairs, NEJM Catalyst and many others. It is an exciting time of moving toward value-based care and collaboration between payers and providers to drive better outcomes."

Mark Friedberg, MD, senior vice president of performance measurement and improvement at Blue Cross Blue Shield of Massachusetts: "Look for a health plan that shares your values as a clinician. Then, within that plan, see if there's a position that makes use of your existing skills (in my case, these were skills in performance measurement and improvement that I developed over more than a decade in health services research) and offers opportunities for developing new ones." 

Eugenie Komives, MD, CMO for North Carolina at WellCare Health Plans: "Administrative and clinical medical decisions are best made by keeping the patient at the center of it all. Patient care has become a team sport in many clinical environments, so you must be prepared to work across multiple areas of your organization and use your influence to keep the focus on what is best for the patient. 'Command and control' are no longer options."

James Polo, MD, executive medical director for Regence BlueCross BlueShield of Oregon: "In my experience, three attributes have been crucial in helping guide my transition as a physician leader in the insurance sector. Humility to admit what you don't know, which underscores the importance of collaboration as a team member with others. Courage to take smart risks that may very well end in failure, but serve as valuable experience to improve clinical outcomes and serve consumers. And finally, a commitment to innovation, played out in practicality by embracing new thinking, perspectives and ways of doing things given that the delivery of healthcare needs to be transformed to be more financially sustainable."

Sanjiv S. Shah, MD, CMO of New York City's MetroPlus Health Plan: "I returned to managed care for one reason only: the opportunity to innovate and collaborate with health systems which are eager to embrace value-based payment structures that reward quality, performance improvement and consumer experience. Socioeconomic factors are inextricably linked to health outcomes, so you have to be ready to work with and learn from the community, activists and local and state government to effectuate meaningful change in favor of the medically underserved. Innovation will emerge from these partnerships if all share a common goal. Physicians in managed care can be uniquely qualified to weigh value and cost to ensure that health outcomes are always kept as the main focus. MetroPlus, a key component of New York City's push to guarantee affordable, quality healthcare for all New Yorkers, is the perfect place for me to work toward achieving my goals, as a doctor and as a physician/leader. My advice to other physicians looking to make the transition to leadership at a health insurer is — find the organization whose goals and objectives most closely align with your own."

More articles on payers:
Aetna ushers in new Kansas leadership with Medicaid contract in jeopardy
Anthem changes how it reimburses autism treatment in Indiana
Aetna, Centene file protest against Louisiana's picks to manage its Medicaid program

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