BY KIM MOORE
A conversation with Majd El-Azma, president and CEO of LifeWise Health Plan of Oregon, followed by the Healthcare Powerlist.
BY KIM MOORE
A conversation with Majd El-Azma, president and CEO of LifeWise Health Plan of Oregon.
Oregon Business: What is the biggest challenge facing the healthplan sector this year?
Majd El-Azma: Navigating all the change tied to the ACA [Affordable Care Act] and making sure that at the forefront of all our thinking is taking care of customers through that process. The rules keep changing. It is really navigating that high velocity of change. At the core, frankly, of all of this is us as an industry, and as a community and as a country, doing something about the continued rising costs of healthcare. At the core of everything we do is trying to tackle the root cause of the costs, and making sure that the program and the products we bring to market have that engineered into our offerings.
OB: How has the Affordable Care Act affected business?
ME: I liken it to a sports metaphor. The commissioner of the league came out one day and said, “Look, we used to play the game this way. We are changing all those rules.” So now the industry has to focus all its energy on making those adjustments. In the middle of all this are our customers. One of the things that the new law is bringing into focus is the much higher focus on retail. Everyone is grappling with how to build the experience — whether it is for the employer or for the actual member or the consumer — in a way that supports them most ideally.
OB: Will the act help reduce healthcare costs and curb wasteful spending?
ME: The biggest portion of that act was around giving access to people across the spectrum. There are pieces within that address the cost. Ultimately, there will be a natural transition from increasing access to people to driving down costs by way of the different innovations taking place in the industry. One aspect the act tries to address is folks who do not have insurance and present themselves in the emergency room. More people have insurance. That more costly, and oftentimes inappropriate, access point for particular situations will be relieved. Therefore, there may be some savings as a result of the waste that was generated. There is a lot of work for us in the industry beyond what the ACA can offer to drive down costs.
OB: What are you doing to address these costs?
ME: We know that costs are a function of how sick or how well you are, times how often you seek care and times how much that care costs. One side of that equation is the delivery system — the partnerships we have with our physicians and hospitals, and what we can do together to drive out waste. On the other side are lifestyles and how sick or well you are — that is really about developing products, programs and services, and, frankly, expertise that help people live healthier lives through habit change. On the delivery system side, we picked a partner in the Portland area and went deep to develop collaborative efforts to drive out waste. On the lifestyles side: We are there to help people live healthier lives and be more engaged in the healthcare system. We have a slew of assets to help. We have an online magazine that is local and relevant called “Actively Northwest.” We have embedded wellness programs in a lot of our health plans. We just launched a program called “Oregon Moves” in partnership with EveryMove. It is an online tracking mechanism for physical activities, so you can track and get rewarded for your physical activity.
OB: Is the market for health plans becoming more competitive since the Affordable Care Act?
ME: Oregon is arguably one of the most competitive healthcare markets in the country. It is interesting because there are easily 10 solid carriers in Oregon. That does not include the national players. We are 3.9 million people — half the size of Washington. We have one of the more progressive regulatory environments; we have lower average incomes in general; there are few Fortune 500 companies. So there is a shrewd consumer base that is very judicious in their purchasing. All of those things make it a hyper-competitive market. The ACA has intensified that. Ultimately, some equilibrium will return to the market, but that turbulence can last longer than we anticipate.
OB: How do you compete with larger health plans in the state?
ME: We try not to be all things to all people. We are careful to pick partners that share our vision of how to drive down costs. We make sure we have the capabilities and the expertise and the people to deliver the best experience toward helping employers and individuals lead healthier lives and it hopefully impacts their pocketbook. How we compete is not trying to do that for everybody. There are some customers who it appeals to and some who it doesn’t appeal to. We are a good fit for those that embrace that philosophy and approach. We will be their help and support along that journey toward better health.
OB: Health plans are becoming more consumer-driven as employers shift healthcare costs to employees. Is this trend here to stay?
ME: It is here to stay. We have seen it in other industries. When you engage folks in their choices and help them manage that responsibility, it can be very effective. It just needs to be done thoughtfully and methodically. There are neat strategies to make those transitions over time. It is incumbent on people who are managing this to find the right partners so they can do it as effectively and efficiently as possible.
|RANKED BY NUMBER OF PLAN MEMBERS IN OREGON|
|RANK||NAME||ADDRESS / PHONE||SENIOR EXECUTIVE(S)||MEMBERS / PROFIT STATUS||PHYSICIANS / NPs and PAs||OR EMPs / YR EST|
|1||Regence BlueCross BlueShield of Oregon||100 SW Market St |
Portland 97201 503-225-5221
|Angela Dowling|| 750,000 |
|2||Moda Health||601 SW 2nd Ave., Portland, OR 97204||Robert Gootee, William Johnson|| 485,000 |
|3||Providence Health Plans||4400 NE Halsey St., Bldg. 2 |
Portland 97213 503-574-7500
|Jack Friedman, Michael White||435,456 |