Q&A … With Matt All

Q: Hit us with your best elevator pitch about BCBSKS, its current strengths and its market position.
A: I’ve been with the organization for 16 years—I was an insurance regulator for a few years, so I’ve been aware of and part of Blue Cross for a long time. And I’ve never been more excited about where the organization is going. It’s a really challenging time in health care—well, it’s always challenging—but coming out of the pandemic, we have a new set of challenges. Our job is probably harder than ever. But we’ve never been stronger or better at what we do. When people encounter the health care system, they’re often in a difficult, vulnerable moment in their lives. They need someone by their side who cares and who’s committed to making that moment better. We believe those moments will be better if they’re with us. 

Q: How are current economic conditions affecting you?
A: This year, for everybody, not just us, has been difficult because the investment markets have been challenging. But because we’ve been very careful over the years, we’ve positioned ourselves to weather that and come out stronger than ever. What really matters to us is the experience our members have in the health-care system. We measure that in all sorts of ways. Nobody wants to need to access health care, but if they go into that system with a Blue Cross of Kansas card and have us behind them, we believe they’ll have a better experience than anyone else. 

Q: You mentioned processes for measuring success. Can you elaborate?
A: In terms of strength, we measure that in several different ways: First, we want to cover as many people as possible, and we cover more Kansans than anyone, by far, and that’s exciting for us. Helping people find peace of mind and a better quality of life is our mission, and if we can do that for more people, that gets us up in the morning. We also need to be financially strong, and we are. We want our members to have a great experience when they need health care, and so we measure that simply by asking them. Where I think the whole industry has fallen short, though, is with affordability. That remains the central challenge of health care.

Q: It’s a challenging time to be in health care. How’s that going for you?
A: That’s another way we measure success–employee experience–and we’re investing a lot in that right now. It’s a challenge because during the pandemic employees’ expectations about the workplace have been scrambled. It has challenged our leadership, and we take it seriously and meet with every new employee, and I tell them the same thing: we want this place to be a good thing in their lives. They have a job where they can work on something meaningful, where they will be given opportunities to use the best of themselves to do great work, but also have plenty of space for a full life, plenty of time for family and to be involved in their community. We’re taking steps to make that better than it ever has been. 

Q: Anything keeping you up at night with forces beyond your control?
A: My goodness, there are so many things. The health care system itself went through real trauma beginning in 2020, and is just now starting to emerge from that. Look, a lot of providers are hurting—they have lost staff, they have staff that are stressed out, and for some, there are difficulties financially, so they are trying to make sense of their own direction and health as organizations. Sometimes that involves money. But one of our biggest roles is to make sure health care is affordable for people, and we have to thread that needle for provider partners who do incredibly important work, while still offering a premium for members that is affordable. That literally keeps us up at night. It’s really hard, because we don’t want to do things on the cheap. If you’re facing a big moment with your health or with a loved one who’s sick or injured, you want the best of care. Finding great partnerships with providers but still meeting the economic needs of our members and groups is really challenging. It always has been, of course, but the pandemic has only made it worse.

Q: What do you see as the biggest potential innovations that might take health insurance in a new direction? Are you already embracing some of those?
A: I don’t think health insurance, as an industry, has been especially innovative. There are reasons for that. We’re pulled from a lot of different directions as the midpoint between providers and patients. They have competing needs that can hold you in place. The other thing is, we’re heavily regulated—and we should be—because things can go very badly if payers act irresponsibly. I think one of the biggest innovations recently has been the expanded use of telemedicine; I think that is starting to mature, and that it will be used in a lot of different ways going forward.

Q: What else has the pandemic experience taught you?
A: I don’t think we, as an entire industry, as a society, have taken mental and behavioral health seriously enough, but I think that’s changing. I don’t think we’ve fully appreciated how integrated and connected mental health is to overall health. The health care providers and the payers that are able to find a way to treat the whole person—behavioral health, mental health, physical health and understanding their linkage—I believe they will be the most effective over the next decade.

Q: Any examples of that playing out with BCBSKS?
A: One thing over the past year, we’ve formed a partnership with MiResource. They connect people to mental health providers that fit that patient and their specific needs, accounting for their cultural preferences, when they prefer to meet, how they prefer to meet, what type of therapy they might need. We’re finding that in many ways, that’s the most important thing. It’s important to get a provider, but it needs to be the right one. 

Q: What about the role of Big Data?
A: It’s something we need to get better at as an industry. We certainly can use data from the payer side, direct people to more cost-effective care and preventive care, and anticipate what else is happening in their lives. But in many ways, sometimes we overthink things, and we assume that using something like Big Data is going to be the solution. What people really want is somebody they can rely on, to be treated with respect, and to have what they’re going through taken seriously, knowing that when they need you, you’re there for them. In some ways, the more important solutions are really the ones that have been there all along.

Q: What are you hearing from your small and mid-size clients in terms of their coverage needs and costs?
A: When the pandemic began, it was all hands on deck, truly an emergency. A lot of normal concerns were thrown out the window. Coming out of it, there’s a perennial concern, which is affordability. Employers are looking for affordable options. And that often means different types of products, like level-funded, that aren’t tremendously innovative, but are on the shelf. One thing we’ve seen is more of the larger payers offering self-funded arrangements for smaller groups than ever before. That’s sometimes a short-term fix, but one that creates longer-term risks, so we counsel members to be very careful about it. 

Q: Other changes that might be helping hold the line on employer costs?
A: In Kansas, we’ve had increased interest in association health plans, and we’re excited about that. We’re working with local chambers of commerce to offer a new association called Chamber Blue. There’s huge interest there. We’ve worked with associations for decades, but wanted to take this on because it has to be managed carefully. If you try to do it with flashy premiums at the outset, it can really undermine stability for those organizations, but if it’s done right, it can really benefit them. For employers, it’s always been about affordability, but recently, we’ve had a lot of employers ask us about preventive care, workplace wellness. Some smaller companies want to get more involved in wellness because they believe that employees who are healthier will use the health care system in ways that are less expensive.

Q: It’s been roughly a decade since the first regulatory guidance for the Affordable Care Act was put in place; did it succeed as public policy?
A: I think it’s succeeded in many ways, but the job isn’t done. In Kansas, we were the only insurer that stuck with it the entire time. In the early years, when the exchange opened, ACA consumers needed a greater level of health care than a lot of payers realized, and across the country, most of them got out. That left a lot of counties with just one carrier, and some with none at all. We stuck it out because we wanted Kansans to have a local option. It was challenging financially, but we don’t regret it one bit. As the pool stabilized, people recognized that it’s a great option for a lot of people without good employer coverage. 

Q: Did it move the needle on costs?
A: Not really, or at least not enough. It did get a lot more people covered. We now have millions of people who can afford coverage who couldn’t before, but that’s because of the ACA’s subsidies, not because the law brought down the overall cost. But the law was written in 2010, and times change—the economic realities, the pandemic, things are more expensive now. We haven’t kept the subsidy levels and the other numbers up to date. As a payer, we have to fit our products in a way the law is written. If Congress takes a new look at ACA, it can help cover more people and allow them to be able to afford more things in life. But its primary goal was to get more people covered, and in that, it absolutely succeeded. For that reason, I think it’s one of the most underrated laws ever passed.

Q: You’ve worn a lot of hats there in 16 years. How did the wide range of executive jobs there set the stage for your leadership?
A: My first boss here, one of my mentors (previous CEO), Andy Corbin, threw me into a whole lot of different roles, probably before I was even ready for them. But … it was a gift. You figure it out. You humble yourself, you ask questions, and you find people who can help you understand the challenges you’re facing.  Andy and I are very different people, but he saw something good in me, and I’ll always be grateful for that. When you’re confronted with something you’ve never seen before, you get better. I learned to solve problems, grow up a bit, developed relationships with a lot of people, and all of that makes you better and stronger, even if it is stressful at the time.