Delivery of Care

One-on-one with Kim Keck, president and CEO of BCBSRI

Keck is leaving after four years at the helm of Blue Cross to assume leadership of the national Blue Cross Association

Photo by Richard Asinof

Kim Keck, president and CEO of Blue Cross Blue Shield of Rhode Island, participating in the virtual launch of the second annual RI LIfe Index in November.

By Richard Asinof
Posted 12/14/20
Kim Keck, the president and CEO of Blue Cross Blue Shield Rhode Island, looks back on her time at Blue Cross before leaving to take a national leadership position.
If Kim Keck can call out the perpetuation of institutional racism in Rhode Island as a major problem, what are the roles that other major corporations in the state can play in identifying and addressing systemic racism? Will Blue Cross Blue Shield of RI be willing to help underwrite the costs of establishing a pilot program for overdose prevention sites in Rhode Island? How involved will Blue Cross Blue Shield of RI become in efforts to change the delivery of Long Term Support and Services in the state? How important is it to have women at the helm of major insurance companies moving forward?
A new book, “Mill Town: Reckoning with What Remains,” by Kerri Arsenault, offers a stunning look at the trade-offs in the life and death of a small town in Maine built around a paper mill complex, and the trail of pollution, disease and death left in its wake that afflicts nearly every resident as a consequence of working at the mill or living nearby.
What began as an attempt by Arsenault to better understand her family’s Acadian heritage back to Prince Edward Island and France uncovers a systematic poisoning of the workers and their families in a company town effectively owned and run by a major paper firm, which once was responsible for printing the clay-coated paper upon which National Geographic magazine was printed.
The story gets at the heart of many major problems with health care delivery in the U.S. – we develop improved treatments for asthma and cancer, but we do not address the causes – air pollution, toxic waste, and harmful industrial byproducts. It also addresses the ways in which we romanticize small town life in a world that no longer exists – and the acquiescence to the destruction of the natural world around the industrial engine.

PROVIDENCE – Kim Keck, the president and CEO of Blue Cross Blue Shield of Rhode Island, will be leaving her current job at the end of the month to head the national Blue Cross Blue Shield Association, the first woman to head the Association since it was established 40 years ago.

Keck had joined Blue Cross Blue Shield of Rhode Island in 2016, after a 28-year stint with Aetna, succeeding Peter Andruszkiewicz.

Among her accomplishments, Keck has been a driving force in the efforts to create the RI Life Index, a survey of Rhode Island residents about how they view the state of health here. [See link below to ConvergenceRI story, “How Rhode Islanders see themselves, during a time of COVID.”]

As a result of the findings, Keck has led efforts bythe health insurer to increase its support of affordable housing in Rhode Island, awarding some $800,000 in grants during the last two years.

In addition, Blue Cross has launched an innovative program targeting Medicare members to offer them services of a primary care provider, Oak Street Health, with the goal of helping older residents “retain your independence, stay mobile, and live well on a budget,” with locations in Warwick, Providence, and Woonsocket.

Further, Keck has been an active partner in efforts to develop a long-term state health plan, working in collaboration with the Rhode Island Foundation.

Here is the ConvergenceRI “exit interview” with Kim Keck, the president and CEO of Blue Cross and Blue Shield of Rhode Island, as she moves into a position of national leadership in the Blue Cross family.

ConvergenceRI: How do you see the future of telehealth in a post-COVID world? Will it require an entirely new regimen of coding and definition of services delivered?
KECK: The pandemic has shown us how important telehealth can be and its use is here to stay. Enhanced telehealth, strategically [and conveniently] integrated with primary care can result in better health outcomes. There are certain types of care that lend themselves to telehealth, such as behavioral health visits, and we expect the use of telehealth in these areas to continue to grow. There are other instances and specialties where an in-person visit remains the best option. Outside of a pandemic, it’s a matter of determining the best way to deliver care.

ConvergenceRI: In interviewing Chris Koller last week, he very clearly stated that housing is not health care. Given the findings of two years of the RI Life Index, do you disagree?
KECK: Chris actually expanded on that statement. He said: “Housing is not health care. It is not reasonable to expect insurance to pay for housing costs. But it is very reasonable to expect that sizable insurer and health system reserves be invested locally in ways that improve the health and well-being of the community – including housing.”

While I agree with Chris that housing is not, strictly speaking, health care, I am sure he would also acknowledge the research that confirms access to safe and affordable housing influences health outcomes.

The RI Life Index underscored Rhode Islanders’ perception that lack of access to safe and affordable housing is a barrier to health and well-being. Blue Cross is committed to addressing social determinants, like housing, to advance our vision of passionately leading a state of health and well-being across Rhode Island.

ConvergenceRI: What do you see as the biggest challenges that a proposed merger between Lifespan, Care New England, and Brown University would create in terms of cost control?
KECK: One of the biggest challenges is ensuring that Rhode Islanders benefit through reduced health care costs, and improved quality and health care outcomes.

Typically, mergers tend to increase costs, while quality declines. Those cost increases would result in higher health insurance premiums, since premiums are driven by health care costs. Regulators must consider these factors when weighing the effects of the proposed merger.

ConvergenceRI: One of the concerns raised at the commission chaired by Sen. Josh Miller looking into health insurance reimbursements were the alleged low reimbursement rates for mental health and behavioral health services in Rhode Island. Given that these services represent one of the highest unmet needs in Rhode Island, how do you think insurers should address the issue?
KECK: Behavioral healthcare has been a priority for BCBSRI for some time. Since 2018, we have invested more than $6 million in initiatives and programs that improve access to behavioral health prevention and treatment.

We also removed prior authorization requirements for all in-network behavioral health and substance use disorder services and launched a provider-focused behavioral health quality grant program to help facilitate closing gaps in care.

In fact, late last week we announced the latest round of our behavioral health quality grants, totaling nearly $700,000, awarded to Providence Behavioral Health Associates, Inc., Lisa M. Rocchio, Ph.D. & Associates, Inc. and Barrington Behavioral Health Services, LLC. Earlier in the year, we awarded $422,000 to Newport Mental Health.

From a reimbursement perspective, we are increasing reimbursement for certain behavioral health codes as of Jan. 1, 2021.

ConvergenceRI: What has been the performance of Your Blue Stores in Rhode Island in regard to increasing members’ participation in health care?
KECK: From 2018 to 2019, we saw considerable increases in the number of people accessing our Your Blue Store locations and participating in fitness programs.

Visits jumped 24 percent to 64,061; class attendance increased 25 percent to 19,228; and fitness class offerings increased 24 percent in 2019 with 2,390 classes.

In addition, referrals to care management increased 350 percent from 2018 to 2019. In 2019, we also opened our fourth Your Blue Store location. That store is located in Cranston.

We’ve made significant changes in our stores in 2020 in response to the pandemic, such as limiting the number of customers in the store at one time and making consultations available virtually. Our yoga classes are incredibly popular, so at the start of the pandemic, we began offering them every weekday for free, through our BCBSRI Facebook page.

ConvergenceRI: What are the three biggest takeaways from your time spent as president and CEO of BCBSRI?
KECK: It’s hard to narrow this down to three, but here goes:

•  BCBSRI has been investing in transforming the health care system to create a system that is based on value – focusing on paying for better outcomes, instead of paying for every discrete service. For example, BCBSRI has invested more than $75 million in primary care infrastructure during the last decade to support this transformation.

These investments paid for embedding pharmacists in primary care practices, adding nurse care managers, and improving technology, among other initiatives, to help primary care providers focus on getting and keeping patients healthy.

Despite this decade-long focus – and despite spending more than 10 percent of our total costs on primary care, where many states spend around 6 percent – transformation has not happened as quickly as we had hoped for.

While we’ve seen some improved outcomes, we have not seen cost increases slow in a material way. To complement our current work and accelerate transformation, we invested in the Oak Street Health community-based model of care, and are involved with, and support, the state’s cost trend effort.

•  Even though we are a health insurer, it is critical that we focus broadly on health and not specifically on health care. Recognizing that up to 60 percent of health is determined by ZIP code and not genetic code, we led – and continue to lead – a range of efforts focused on addressing the life factors, or social determinants of health, that impact overall health and well-being.

For example, we work to influence significant policy changes at the state level that will benefit historically underserved populations, with the goal of improving health outcomes, increasing access, and eradicating inequities.

We also convene community partners around a variety of initiatives, including the RI Life Index, and our campaign to eliminate the stigma associated with behavioral health issues and substance use disorder. Our deeply rooted community mission drives our work in this area.

•  Finally, a big takeaway for me is that Rhode Island has an enormous advantage over other states when it comes to the ability to productively collaborate. Our size makes it possible for leaders from every sector not only to convene around important issues, but also to take collective action.

I can think of a number of examples, but I will cite two that I have already mentioned here: The cost trends target, created by the cost trends steering committee [we are one of only three states to set such a target; and the RI Life Index, which was developed in less than a year as a sustainable, annual initiative.

ConvergenceRI: How involved has BCBSRI become in supporting community recovery groups promoting peer recovery and harm reduction activities?
KECK: BCBSRI has been very involved in supporting peer recovery and making it available to our members for the past five years. New for 2021 is that as of January 1, we will make peer recovery available to our Medicare Advantage members. For that initiative, we are working with East Bay Recovery Center, Fellowship Health Resources, Thundermist and Anchor.

ConvergenceRI: In promoting health equity and racial equity, what do you see as the role of insurers in supporting Health Equity Zones in Rhode Island?
KECK: BCBSRI has a vision to passionately lead a state of health and well-being in Rhode Island and health and racial equity are natural components of that vision. That’s why we launched the RI Life Index in 2019.

As I see it, we have three crises dominating our landscape today – the COVID-19 pandemic, the perpetuation of institutional racism, and a severe economic downturn – and all three have disproportionately affected the most vulnerable Rhode Islanders – people of color, those with low-incomes and people with disabilities.

We have to do everything we can to address these inequities to improve the health of all. BCBSRI is working with the Health Equity Zones to share the data from the RI Life Index and to learn how best we can translate that data into action.

In addition, since 2016, BCBSRI has certified 30 provider practices as LGBTQ Safe Zones to help ensure the LGBTQ community has access to quality, sensitive care.

ConvergenceRI: Data integration and interoperability remains a big challenge for the health care delivery sector. What role would you like to see Blue Cross play in developing new digital platforms?
KECK: This is an area of challenge and also one of great opportunity. During the pandemic, our data and analytics team created a COVID-19 public health dashboard to help identify those members most at risk of COVID-19.

We were able to share this information with what we call our systems of care, or accountable care organizations, to help providers reach out to those patients. The dashboard incorporates the CDC’s social vulnerability index.

We are also working with the provider community on electronic health record data integration to help facilitate identifying and closing gaps in care.

ConvergencRI: In a recent investigation by STAT, reporters found that there was a problem of what they described as "embedded racism" in how algorithms were being deployed [in particular, they looked at Optum]. What kinds of best practices would you recommend that Blue Cross develop to protect against such problems in deploying algorithms around health care?
KECK: This is a big question that many health care organizations are actively addressing today. BCBSRI, along with the other 35 Blue plans nationwide, signed a pledge in June 2020 to fight racism in our country by taking tangible steps to put a stop to injustices, and remove barriers preventing equitable health, well-being and safety.

At BCBSRI we have redoubled our efforts around equity. Safe Zones, mentioned above, are a great model for this work. Recognizing that the LGBTQ community struggled to find providers who understood their particular health needs, we created Safe Zones. In the process we abandoned pre-conceived notions about care and used data to inform the model. A similar approach will be needed to overcome embedded racism in health care.
There are many learned behaviors to be undone. The good news is with an increased focus on this issue and an abundance of relevant data available, I believe we’ll make rapid progress.

ConvergenceRI: What questions haven't I asked, should I have asked, that you would like to talk about?
KECK: You’ve covered a lot of ground in these questions. I have nothing to add.

ConvergenceRI: What kinds of stories do you think ConvergenceRI needs to do a better job in covering and reporting on?
KECK: Keep asking the tough questions and keep listening.


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