BCBS of Arizona CMO on greatest challenges facing health insurer execs

Blue Cross Blue Shield of Arizona appointed James Napoli, MD, its CMO June 12.

Dr. Napoli became interim CMO of the health insurer in March. At the time, he also served as BCBSAZ's enterprise medical director for healthcare ventures and innovation.

Board-certified in internal medicine, Dr. Napoli has more than 10 years of clinical experience in hospital medicine and physician leadership roles at Arrowhead Hospital in Glendale, Ariz.

Here, he answers four questions from Becker's Hospital Review on his new role, the greatest challenge facing health insurance CMOs today and what makes a great payer executive.

Editor's note: Responses have been lightly edited for length and clarity.

Question: You've been interim CMO since March. What excites you most about taking on the full role?

Dr. James Napoli: I am most excited about how my team and I will be working to transform care delivery in our marketplace by continuously improving the consumer experience, achieving even higher standards in patient outcomes, and enhancing the value of the product and services Blue Cross Blue Shield of Arizona offers. In this role, I'll also have the ability to be more connected to our provider community to gather provider feedback and ensure that we are truly aligned with providers and are collectively working together to improve healthcare for all Arizonans.

Q: What is the greatest challenge facing health insurance CMOs today?

JN: One of the greatest challenges in healthcare today is also the greatest opportunity for our industry. To deliver quality and affordable healthcare, we need to leverage new technologies to develop innovative payment designs and inventive solutions for healthcare delivery. There are so many different technologies and new ideas for engaging patients, and we need to understand what works best in our marketplace to help drive better clinical outcomes. Without better clinical outcomes, healthcare cannot be affordable or sustainable. That's why, at Blue Cross Blue Shield of Arizona, we have such a strong focus on technology and data. As CMO, it's important to make sure that data informs all healthcare delivery models and is shared with our partners in an integrated manner, allowing physicians to provide meaningful and measurable care that is aligned with our population-health management goals.

Q: What skills are essential for a payer executive in today's healthcare climate? 

JN: There are five skills that are key to my team and I, and they are something we regularly discuss. Those are: 

  • Passion for inspiring health: A belief in doing the right thing for members to inspire health and improve care delivery for all parties — patients, payers and providers. Everyone benefits from better clinical outcomes and doing the right thing for our members. 
  • Focus: To focus on priorities and have discipline around this focus allows us to stay true to our strategy and deliver results.
  • Communication: Communication is key to helping our internal teams, external customers and partners understand what we are trying to do, and ensure transparency. We want to work closely with the entire medical ecosystem to better understand the constantly evolving marketplace and involve them in the decision-making process to collaboratively create our mutual goals.
  • Adaptability: It's incredibly important to be able to change and adapt based on market demands, medical trends in data, and consumers' wants and needs. 
  • Accountability: We are accountable for our work to each other and to our partners, and we are driven to reach our goals. We are committed to delivering results and meeting our objectives.

Q: As the healthcare industry shifts to value-based payments, what is the biggest challenge BCBSAZ is facing? What strategies are you deploying to meet this challenge? 

JN: The most important thing for us and the industry is data — being able to give providers clean, reliable, real-time- or near-time-actionable data. If we can give providers data at the point of care delivery, and they are aligned with our goals and our payment models, we'll see better outcomes and will more easily transform to value-based care models.

Better health outcomes for patients requires that the entire medical ecosystem be aligned and working together toward the same goals. Every component must be in sync — doctors, hospitals, therapists, labs, radiology, etc. Data and clinical information flow that is integrated and consumable provides the best opportunity for success in a fee-for-value model of care. This is the key to the success of value-based payment systems. 

Blue Cross Blue Shield of Arizona is working hard to meet these challenges, including improving our systems with a significant investment in the most updated and sophisticated technology available, and collaborating closely with our providers to deliver data that synchronizes with their daily workflows and processes. 

Blue Cross Blue Shield of Arizona is also:

  • Working with the health information exchange in Arizona to collect integrated data, including the creation of a longitudinal medical record. 
  • Improving our digital technologies to activate and engage patients in their own care, as well as working with providers to improve patient access to care.  
  • Eliminating the barriers to care, as well as unnecessary visits to emergency care settings. We have programs to help with the transition of care to and from different settings, as well as ensuring care is delivered in the appropriate setting with various care-coordination efforts.  
  • Engaging in a holistic approach to improve healthcare delivery, one that will allow us to inspire health while delivering affordable and innovative healthcare solutions to our members. We view behavioral health solutions — particularly those that integrate into medical health — as a key to healthcare delivery moving forward.

    More articles on payers:
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    Where is the payer-provider relationship headed? 17 healthcare execs weigh in
    UnitedHealthcare CEO to retire: 5 things to know

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