5 Things We Must Do To Improve the US Healthcare System: With Maureen Sullivan, Chief Strategy and Innovation Officer at Blue Cross Blue Shield Association & Limor Weinstein

Would you be surprised to learn that six of the top 10 conditions that affect our ability to achieve optimal health are tied to behavioral health? Reducing the stigma around mental health is where we need to begin. And we need to make it easier to access care for behavioral health issues. That is one […]

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Would you be surprised to learn that six of the top 10 conditions that affect our ability to achieve optimal health are tied to behavioral health? Reducing the stigma around mental health is where we need to begin. And we need to make it easier to access care for behavioral health issues. That is one of the reasons we are focused on integrating medical and behavioral health.

As a part of my interview series with leaders in healthcare, I had the pleasure of interviewing Maureen E. Sullivan, the Chief Strategy and Innovation Officer at the Association (BCBSA), a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies. The Blue System is the nation’s largest health insurer covering one-in-three of all Americans.

Sullivan has overall accountability for BCBSA’s strategy, marketing, development and innovation, research, group purchasing, strategic communications and educational programs. In this capacity, she leads several teams in providing wide-ranging services and strategic counsel to BCBSA leadership and BCBS Plans.

Among the critical thought leadership initiatives Sullivan drives on behalf of the BCBS System are efforts to effectively leverage BCBS data to bring new insights to healthcare. This suite of programs includes the Blue Cross Blue Shield Health Index, a first-of-its-kind measure of community and national health; the Health of America report series, which highlights data-driven information on timely health topics; and the Alliance for Health Research, a partnership with leading academic institutions.

Sullivan earned a master’s degree in public policy from the John F. Kennedy School of Government at Harvard University where she was a Kennedy Fellow. She also holds a bachelor’s degree with honors from Albertus Magnus College in New Haven, Conn.

Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?

I started at Blue Cross and Blue Shield Association right out of graduate school. I planned to stay two to three years, and it turned into a long career. My graduate degree is in Public Policy and I am very motivated to work where we are making a positive difference in people’s lives. That drive comes from both my parents who were social workers.

Can you share the most interesting story that happened to you since you began your career?

One of the interesting developments in my career came when five years ago we formed a partnership with Bupa to extend Blue Cross Blue Shield to our customers with team members located overseas as expats. Together we own a company that provides international coverage — Blue Cross Blue Shield Global. Bupa operates in 190 countries around the world. Learning how the health systems may be different, but the health challenges are very similar is enlightening.

Can you share a story about the funniest mistake you made when you were first starting your career? Can you tell us what lesson you learned from that?

I’ve made plenty of mistakes in my career, not all of them were funny, but I learned from them all. Those I laugh at the most now are the ones that happened when my two daughters were young and I was balancing a demanding job with raising the girls on my own. I would find myself at work with shoes that didn’t match — literally — two black flats mismatched. One had a bow and the other a buckle. One earring would be in and the other at home on the floor. As long as I made it to the school events and was home to make dinner often, I didn’t worry about the inevitable mishaps.

What do you think makes your organization stand out? Can you share a story?

The Blue Cross and Blue Shield Association is unique. We license the Brands to the independent BCBS Companies and provide supporting services. It gives us a view of health care at both the national and local level. I am inspired every time I visit one of the BCBS companies and hear about what they are doing to improve health in local communities. One of the stories that moved me recently happened in New York. An Excellus BlueCross BlueShield member who had high blood pressure hadn’t been answering calls from his nurse case manager, so the nurse case manager drove through snowy upstate New York to meet the member in person and help him enroll in a case management program to stay on track with his medications.

What advice would you give to other healthcare leaders to help their team to thrive?

We have an incredibly talented team at Blue Cross Blue Shield Association. In the Strategic Services division that I lead, we have many who begin their careers in our group. I’ve seen team members go on to become leaders in many sectors of healthcare. What helps our team thrive is having the ability to balance the engaging work with personal interests. The intellectual stimulation that comes from having such a talented group is clearly a big part of why I decided to build my career at BCBSA.

OK, thank you for that. Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

That report was shocking to me as well. Our number one goal is to make sure people have access to affordable, quality health insurance, and we have a long history of serving the community so people can have the security and stability that comes from having quality coverage. We’re working to improve our healthcare system by focusing on providing access in rural areas, collaborating with doctors and community partners to address social factors and environmental conditions in which people live, and addressing the rising costs of healthcare.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.

1). All Americans should have universal access. Better health begins with having access to care. I’m reminded of a program at Blue Cross Blue Shield of South Carolina that provides free vision screenings to daycare- and preschool-aged children in lower-income populations. One three-year-old in particular comes to mind. He was diagnosed with two conditions that would have otherwise interfered with his education and required invasive treatment. By catching them early through this screening program, he can now live life as a normal, healthy kid — riding four-wheelers and playing basketball with his mom.

2). All Americans should have consistent primary care emphasizing prevention, integrating medical and behavioral health, and supporting social needs. The emphasis on primary care is one of the most important changes on this list of top five. It is through strong primary care that individuals can prevent disease or better manage a condition. The development of the patient centered medical homes are really transforming care in the community. For example, Blue Cross Blue Shield of Michigan has designated PCMH practices in most counties. These doctors receive incentives for the quality of care they provide — including coordinating all of a patient’s care, focusing on chronic condition management, and offering extended office hours. Many reinvest those financial resources into hiring additional staff. A few have actually embedded pharmacists on their teams to help advise patients. Because of their focus on prevention, last year, Michigan’s PCMH practices had 25 percent fewer chronic-disease related inpatient stays than non-PCMH practices.

3. Physicians, hospitals, and pharmaceutical companies should be paid by health outcomes, not volume. Paying for outcomes or paying for value is increasing prevalent for hospitals and physicians. Blue Cross Blue Shield already has 41 percent of claims with value based care. Yet, those payment innovations are only just starting with pharmaceuticals. Why is this important? Blue Cross Blue Shield of Massachusetts developed an innovative way to pay for care that focuses on promoting quality and reward positive health outcomes. The New England Journal of Medicine found the model improved patient care and lowered costs with accelerated savings of 10% in 2012 and that value continues to this day.

4). Information should be widely available on where to get care and how to improve health. We are fortunate to have information so easily available. It is encouraging to see the new ways information is being made more accessible to help us make decisions on accessing care. For example, in many industries, a higher price tag often means better quality or value, but many consumers don’t know this is not the case in health care. Blue Cross NC’s SmartShopper pays customers cash for choosing the most affordable doctors and hospitals that deliver quality care. Prices for procedures can vary by thousands of dollars even in the same town. The program drives awareness of these cost differences.

5). Proven advances in healthcare should be rapidly adopted. It is difficult for physicians to keep up with the medical advances particularly given the rapid development of technology and therapies. We need to develop ways that those advances reach those living in rural areas as fast as the urban areas. Whether that is through providing access to Centers of Excellence or new telehealth devices, there is a need to develop consistent care treatment approaches that are most effective. Blue Cross Blue Shield is also embracing pilots where we can explore “real world evidence.” Learning what interventions work is the first step before scaling solutions.

OK, it’s very nice to suggest changes, but what concrete steps would have to be done to actually manifest these changes? What can a) individuals, b) corporations, c) communities and d) leaders do to help?

As you can see from the examples, there are already positive steps being made to improve health in local communities. What is critical is developing the public-private partnerships that will enable a health care system that delivers better results for all Americans.

As a mental health professional myself, I’m particularly interested in the interplay between the general healthcare system and the mental health system. Right now we have two parallel tracks mental/behavioral health and general health. What are your thoughts about this status quo? What would you suggest to improve this?

Integrating medical and behavioral health is one of the priority areas many BCBS companies are exploring. The BCBS Health Index, which measures health across every zip code, identifies the top conditions affecting our ability to have optimal health. Would you be surprised to learn that six of the top 10 conditions are tied to behavioral health? Blue Cross Blue Shield just released a study on the health of millennials and learned that millennials have a much higher prevalence of behavioral health conditions than the generation before them. Reducing the stigma around mental health is where we need to begin. And we need to make it easier to access care for behavioral health issues. That is one of the reasons we are focused on integrating medical and behavioral health.

How would you define an “excellent healthcare provider”?

This is a great question as finding an excellent healthcare provider can influence the quality of care a patient receives. Defining excellence is going to be a very personal decision for any patient, but part of coming to that conclusion is in knowing the right questions to ask your provider. Understanding things like how many times they’ve completed a procedure or surgery can help patients determine a provider’s excellence and ensure they’re receiving the highest quality of care. At Blue Cross Blue Shield, we offer the Blue Distinction specialty care program where we recognize healthcare providers for their quality care and patient results.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

I’ve had the good fortune to work for a terrific boss for over 20 years — imagine that! Scott Serota taught me a lot about how to balance work/home, the importance of listening in a leadership role, and the value that comes from keeping things in perspective. Scott has a fun saying — “this too shall pass.” I remember that whenever what is in front of me seems like an intractable issue.

Are you working on any exciting new projects now? How do you think that will help people?

One project I’m passionate about stems from our recent report on millennial health.With millennials on track to become the largest generation in the near future, we want to address this issue now to ensure millennials, and all Americans, take a proactive role in maintaining their health and wellbeing. To identify key drivers of millennial health and how to improve it, BCBS companies will host Millennial Health Listening Sessions across the country. Through these workshops, BCBS companies will hear from millennials, leading health care experts, employers and digital leaders on how to improve the health of millennials.

What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?

I am an avid reader of both fiction and non-fiction. There are always good takeaways from traditional management and innovation books. Yet, I draw the most learnings from reading/hearing from those who have been in the throes of leadership challenges. Along that line, my favorite podcast right now is The Oath with Chuck Rosenberg. While not focused on leaders in health care, the lessons on the importance of leading with integrity and managing through change are invaluable. I also heard Indra Nooyi speak recently at the BCBS Annual Summit. Indra is inspiring, particularly how she focused PepsiCo on a purpose-driven future, and the value that came from that — not only for shareholders, but employees as well.

You are a person of great influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

I think the work we’re doing at Blue Cross Blue Shield Association to ensure all Americans have access to healthcare is a bold movement, and one of great magnitude. I’m very driven to make a positive difference in people’s lives and think providing people with coverage that allows them to live healthier lives is of the utmost importance.

How can our readers follow you on social media?

Follow me on LinkedIn here:

About the Author:

Originally from Israel, Limor Weinstein has been anorexic and bulimic, a “nanny spy” to the rich and famous and a Commander in the Israeli Army. Her personal recovery from an eating disorder led her to commit herself to a life of helping others, and along the way she picked up two Master’s Degrees in Psychology from Columbia University and City College as well as a Post-Graduate Certificate in Eating Disorder Treatment from the Institute for Contemporary Psychotherapy.

Upon settling in New York, Limor quickly became known as the “go to” person for families struggling with mental health issues, in part because her openness about her own mental health challenges paved the way for open exchanges. She understood the difficulties many have in finding the right treatment, as well as the stigma that remains so prevalent towards those who are struggling with mental health issues. She realized that most families are quietly struggling with a problem they’re not comfortable talking about, and that discomfort makes it much less likely that they will get the help they need for their loved ones. She discovered that being open and honest about her own mental health challenges took the fear out of the conversations. Her mission became to research and guide those families to the highest-quality treatment available. Helping others became part of her DNA, as has a commitment to supporting and assisting organizations that perform research and treatment in the mental health arena.

After years of helping families by helping connect them to the right treatment and wellness services, Limor realized that the only way to ensure that they are receiving appropriate, coordinated and evidence-based care would be to stay in control of the entire treatment process. That realization led her to create Bespoke Wellness Partners, which employs over 100 of the best clinicians and wellness providers in New York and provides confidential treatment and wellness services throughout the city. Bespoke has built its reputation on strong relationships, personalized, confidential service and a commitment to ensuring that all clients find the right treatment for their particular issues.

In addition to her role at Bespoke Wellness Partners, Limor is the Co-Chair of the Academy of Eating Disorders. She lives with her husband, three daughters and their dog Rex in Manhattan.

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