Vindell Washington, MD, transitioned from the provider and health IT sectors to become CMO of Blue Cross and Blue Shield of Louisiana June 8.
A board-certified emergency medicine physician, Dr. Washington served as the National Coordinator for Health IT in HHS before joining BCBSL, based in Baton Rouge. Prior to that, he worked at Franciscan Missionaries of Our Lady Health System in Baton Rouge for more than seven years. He left the health system as president of the medical group with more than 500 providers and 1,400 employees.
Dr. Washington spoke with Becker’s Hospital Review about how he integrates this experience as an emergency medicine physician and health IT leader with his current role.
Note: Responses have been edited for length and clarity.
Question: How has your previous role at HHS influenced your position at BCBS?
Dr. Vindell Washington: I think the main activities that we're chasing on the payer side, at our company particularly, is an effort around cost containment, quality, provision of services for members and a focus on community. A lot of what we did at HHS was parallel to that. We talked about better, smarter, healthier as an approach. Better was related to quality, smarter was related to cost and healthier was related to the health of the community.
In particular as a national coordinator, we focused on the flow of information. We tag lined it as interoperability and focused on EHRs as a central part of that.
Q: How do you think your experience as an emergency physician affects your role at BCBS?
VW: I think there are certain insights you bring to the table that help parse some of the nuances in the system. For example, we spend a lot of time on the payer side with reporting hospitalization and emergency department visits. Having spent 20 years in an ED, I think that brings a particular insight as to what you can address and what should be addressed. Clearly not every visit to an ED is a care failure — I've heard that sort of discussed or even debated among some sectors. That's not what I believe as a provider who has been in the space.
On the other hand, there are certainly a lot of instances where patients present to the ED because they don't have access or they have a chronic disease that is poorly managed. Those visits are ones that tend to be not only frustrating for the patient, but also frustrating for providers of services because you often have difficulty providing the continuity of care those patients need. And they're costly for the entire healthcare ecosystem.
I remember in the early 1990s I also participated in activities around the concept of prudent layperson's approach to emergency care. From my perspective, the key portion there is patients don't walk around with their diagnoses on their forehead. Chest pain may be benign; it may be a very serious condition. For patients with newly presenting conditions, particularly with potentially catastrophic outcomes, the ED functions best and at its highest, most appropriate level. We're trying to make sure our areas of focus are much more nuanced in directing patients and making sure they get care at the right delivery area. I think that's the No. 1 value proposition from a payer perspective.
Q: What are your thoughts on balance billing debates concerning emergency care?
VW: I think emergency physicians recognize we as a specialty have this relatively large unfunded mandate. The unfunded mandate comes from laws around the Emergency Medical Treatment and Labor Act and other laws that essentially require patients to be treated. For me, it was a comfortable ethical place to be. I never wanted to be in a situation where I had to refuse care based on cost or a patient's ability to pay.
But I also certainly recognize emergency physicians are in a situation where sometimes 30 percent of the patients they see are not covered from an insurance perspective and don't have any payment source. In my old group practice, we also had a very large Medicaid population and sometimes the state payments didn't cover the cost of care for patients.
At Blue Cross, we've been supportive of the expansion of healthcare coverage. What that did, and what it did for Louisiana, is make sure that unfunded mandate was funded. I think the big question is less about balance billing and it's more about are we going to have most of our citizens covered for care and services? BCBS has remained in the individual market. We're one of two providers in the state that are committed to that activity. We think it's an important thing to have care coverage for those folks who are seen. And I don't think it's necessarily a case of having insurers pitted against emergency medicine providers.
Q: What has been the greatest challenge you faced since joining BCBS as CMO?
VW: One area that's been a stark outlier is pharmacy costs, and what is going to be the long-term strategy on pharma costs, particularly outpatient pharma. The first month I got to work, I reviewed some of the macro cost data at Blue Cross. From 2009 to 2016, there's been a 7 percent increase in paying for pharma. It went from a period where hospitals [stayed flat], maybe up a penny on the dollar. Pharma has gone up 7 cents, physician payments have gone down 7 cents on the dollar and the administrative costs for Blue Cross have gone down about a penny. That's a heavy pressure from pharma in this space. I'd probably be a little more sympathetic if it's what I expect to see soon in the future, like a big introduction of genetically-oriented precision medicine-type drugs. But a lot of the increase in this space is from things that have gone out of patent, coming back at these super-high prices and new drugs that are combinations of over-the-counter drugs.