BCBS Minnesota’s Dana Erickson: Looking to the Future, Together with Providers

Things have been moving forward rapidly at Blue Cross and Blue Shield of Minnesota (BCBSMN), that state’s largest commercial health plan. Based in the Minneapolis suburb of Eagan, BCBSMN ensures more than 2.5 million members in Minnesota and nationwide. With the largest share of commercial plan members in Minnesota, the leaders at BCBSMN having been focusing on advancing value-based purchasing in healthcare, as well as healthcare equity, among other key goals.

Back in the summer of 2020, BCBSMN’s leaders made headlines by signing a long-term strategic agreement with the leaders of the Minneapolis-based, 11-hospital, 90-clinic, Allina Health System. As a press release posted to the health plan’s website on August 27, 2020, stated, “Following more than a year of collaboration and planning, Allina Health and Blue Cross and Blue Shield of Minnesota (Blue Cross) today announced a six-year, value-based payment agreement between the two organizations, which collectively serve a significant percentage of Minnesotans. Allina Health performs more than 6 million patient visits per year, while approximately one in three residents in the state have coverage through Blue Cross. The agreement is designed to provide enhanced value for Blue Cross members while fostering even more high-quality care and healthy outcomes that Allina Health is well-known for across the state.”

That press release went on to say that, “Months prior to the onset of the COVID-19 pandemic and its impact on nearly every aspect of the American health care system, Blue Cross and Allina Health began reimagining the traditional construct between provider and payer in order to better align the relationship around a shared vision of lower cost, higher quality and more accessible health care. The pandemic underscores the timeliness and importance of this agreement, which will provide more stable and predictable revenue, while supporting care models that aim to improve individual and community health.” And, importantly, the press release noted that “The new agreement aims to reduce the cost trend of Blue Cross-specific care at Allina Health by 10 percent over five years. Notably, the portion of payments made by Blue Cross that are tied to achieving optimal patient outcomes are 5-to-10 times larger than what is outlined in typical outcomes-based risk arrangements.”

Dana Erickson, R.N., who had been deeply involved in creating that long-term agreement with Allina Health, became president and CEO of Blue Cross and Blue Shield of Minnesota on November 1, 2021. Since then, Erickson has been moving full-steam ahead with value-based healthcare and health equity initiatives. She spoke recently with Healthcare Innovation Editor-in-Chief Mark Hagland recently, regarding everything going on BCBSMN, and her goals for the organization. Below are excerpts from their interview.

What have your first several months like been, since you became CEO of the organization?

It’s actually been an amazing last eight or nine months. And I had been with the organization for several years. And I’ve felt so much support from the board and executive team. And it’s given me the ability to leverage some of the relationships I’ve had, and getting out and listening. Among other things, I’ve been getting a team in place, and have been meeting with employer groups, to hear what are they saying, and how they’ve been thinking about healthcare. So, I’ve been talking with employers, brokers and agents, members, and providers.

I was able to pivot to the creation of a new strategic plan that will roll out in 2023. We wanted to make sure that our strategic plan was aligned with what our customers needed. It’s a three-year strategic plan, for 2023-2025.

What are your top goals for BCBSMN going forward?

What we’ve heard with some consistency, though everything is nuanced in this new world—but, first and foremost, affordability. It’s the number one thing we continue to hear from our members and from our employer-purchasers. So affordability absolutely has to be a key priority; also, medical claims, and challenging ourselves on automation. The second big theme is around consumerism and ease of use. There’s lots of things we all want to lose from the pandemic, but one thing I hope we don’t lose is expectations around how healthcare is consumed, and where. As you know, telehealth had seen low utilization, but all of a sudden, overnight, it was everywhere. And I think that’s changed expectations among consumers; and I think that’s good. So, ease of use is a huge theme for us. And then the third thing is, and it’s something we’ve been very focused on, is health equity. COVID illuminated that for us, and certainly, we were at ground zero here in Minnesota—the entire situation around George Floyd and everything related to that. So we’ve taken some different approaches around how we partner across the Blues system nationally, but apply it locally as well.

How do you feel about this moment in payer-provider relations, after some difficult months during the height of the COVID-19 pandemic, when things have become more difficult financially for providers, particularly as the bulk of their reimbursement remains in fee-for-service payment?

I feel a great sense of accountability in terms of how we show up as Blue Cross and Blue Shield of Minnesota, at a very important time. And I’m a nurse by heart. I lived in the patient care world for a long time. And they’ve had a pretty rough time in terms of burnout, backlash, everything. So providers are in a pivotal time right now in terms of workforce, etc. So we have a responsibility to lean in as a collaboration. And with a background as a clinician and in terms of our history at BCBSBN, because of our not-for-profit status, we need to lean in as partners with providers. We all have the same goals. And there are crises facing all of us. And because we have spent several years working with providers like Allina, on longer-term, value-based relationships, that gives us an opportunity to be innovative around contracting. And when we look at value-based contracts, while primary care providers are aligned to it, there are pitfalls. We call it “ramping up.” It requires a partnership. We want joint accountability in the support of the models, and how we support them around data and collaboration, and equity. So first, we’re focusing on our role as a trusted collaborator: how do we help support you? Because that supports Minnesota. And truthfully, we want to be the glidepath, to help them.

What would you say to providers, to encourage them forward further into value-based contracting?

At the end of whatever measurement period, say, two years, if they’re not performing well and are having to cut us checks, that’s a fail for us, too. So, creating a glide path for them for success. When I first started having these conversations with providers a few years ago—it goes back to my clinical background—if we don’t have clinicians in the room, how will they be successful? And I was quite adamant that we needed to get the clinicians in the room, so it wasn’t just a contractor-to-contractor conversation. They need to see that their success is our success, truly. And the second element is what we call “trust-busters.” And no matter which provider and payer are involved in contract negotiations, there will have been some negative history. So we say, let’s put those trust-busters on the table. It could maybe be prior authorization work, or investment in data and analytics—but we would list out some trust-busters we could address to prove our commitment. We’re willing to put some things on the table and remove that barrier for you, and move forward. But it has to be based on trust built up over time. We had worked through the contract with Allina by March 2020, and then the world shut down on March 13. And my first call was to their CFO, saying, don’t freak out—we can all mange this together.

Do you find the trust does build over time?

Yes, it’s really the difference between a contractual relationship and a strategic partnership; the work doesn’t stop when we sign a contract, that’s when the work starts. How do we move forward together, to help our community? I feel super-blessed to be in Minnesota, where I think our payer and provider systems are all aligned around community and health equity. So it does feel more like a strategic partnership. The outcome for members and patients can be so much richer in these models, where you’re talking about experience and how to exchange data.

How do you see the collaborative potential between plans and providers on the deep work involved in clinical transformation?

Even within our walls, we have responsibility for transformation. We need to constantly question what’s value-add and not, and constantly work on transformation. But also, we work a lot with some of our independent primary care groups. We’ve got critical access hospitals and smaller primary care groups in rural areas, and we work a bit differently with them. With the bigger systems, we tend to focus on broad outcomes, like patient access. How do we put the patient in the center and then look at the onboarding process, for example? How do we improve access to appointments and care? So those are a couple of areas where we’ve sat down with providers and said, we really want to focus on experience, because that helps us both grow. And we can look at process where we’re duplicating efforts. On the independent-physician side, we’ve helped them with investing in technology to address gaps in care. So, giving them technology solutions. And we even provided a grant to a rural system to buy a birthing simulator. There are over 20 counties in the state that struggle with how to deliver babies. So it’s really understanding where your providers are struggling. If we keep that member focus in the middle, that helps us all.

What will be the biggest challenges for you as an organization in the next few years, and how will you address them?

The continuing push towards technology and personalized healthcare—addressing technology needs. For example, the transparency rules in healthcare. So the ongoing digitization of technology in healthcare will be a focus, but how do we do that in a way that ensures privacy and security? And, at the end of the day, it will still be affordability that will have to be a focus.

And having your feet in two canoes, a provider will say, having a very small APM [alternative payment model] contract won’t change your business model. So affordability will still be the biggest challenge for us. And then there’s equity. And even though there’s a lot to learn from Amazon, with OneMedical, etc., but could digitization leave people further behind? Our goal is to decrease that gap. As a nurse, when I look at infant mortality, the statistics are appalling. We don’t want to expand the digital divide.

Do you support hospital-at-home programs?

We absolutely do support them, and we do have some provider systems here that have been creating those programs. And to me, that’s an opportunity: let’s figure out how to support it. And right now, there’s a capacity issue in hospitals as well; they don’t have enough ICU nurses, for example. And also, the home is where people want their care. So, I fully support it.

And you built a lot of data collaboration into the contract with Allina, correct?

That’s right, it was one of our trust-busters, meaning one of the elements to help destroy mistrust. And maybe getting care somewhere else. We really are the holders of the data in a much more tangible way sometimes than providers. So yes, it’s something we continue to evolve. The one area we’re all still working on together is getting the demographic data in there, on race, language, etc., data points to help us identify individuals at risk—bringing that data together between provider and payer; if we have a lens on that, it really helps us with analytics on who those populations are. And how do we bring in some of those different aspects of data, to do proactive outreach during the most serious time of COVID, for example. And so data and technology are foundational components. And one area we’re focused on is helping to push everybody on gathering race, ethnicity, and language data, and making sure the data is gathered in a place where it can be used.

What do the next few years look like for you?

We are very optimistic; we’re the market leader in Minnesota, which we’re very proud of, but we can never rest on our laurels. We’re the oldest Blues plan in the nation, we’ll be 90 years old next year. And we were born out of a provider system. So we’ll keep moving forward. And I’m super-proud of our mission, around helping everyone to achieve their best life. And of our partnerships with providers and others. Whether it’s through tobacco or our emphasis on racial health equity, all those things are very important to me.