Class explores the role of insurers in health care
April 5, 2023 – Can health insurers be good?
That’s the question that Andrew Dreyfus, recent president and chief executive officer for Blue Cross Blue Shield of Massachusetts (BCBSMA), is asking students to explore during a course he’s teaching this spring at Harvard T.H. Chan School of Public Health.
Dreyfus, a Richard L. and Ronay A. Menschel Senior Leadership Fellow at the School, acknowledges that health insurers are often viewed negatively. But in the course, he is focusing on cases in which private plans—particularly not-for-profit plans, like BCBSMA—have worked to advance health care reform.
“There’s been a lot of focus at the School and other graduate programs on health care, medicine, and public health, but very little on the role of health plans and health insurance companies,” Dreyfus said. “It struck me it would be a good topic.”
For the course, “Can Health Insurers Be Good? The Potential and Limits of Health Plans as Agents of Health System Change,” Dreyfus is drawing on his 21 years of experience working at BCBSMA—a dozen as CEO, five as executive vice president of health care services, and four as president of the Blue Cross Blue Shield of Massachusetts Foundation. Prior to that, he worked in key roles at the Massachusetts Health & Hospital Association and in state government.
Dreyfus is the latest in a roster of leaders—from government, multilateral institutions, nonprofits, and journalism—who have taught at Harvard Chan School as part of its Senior Leadership Program. Previous Fellows have included former New York City Mayor Bill de Blasio, former Boston Mayor Kim Janey, and former Costa Rican ambassador to the U.S. Roman Macaya.
A different view of health plans
On the first day of the course, Dreyfus asked the students to say what comes to mind when they hear the phrase “health insurance company.” He got a lot of negative comments. “That’s what I anticipated,” he said. “I told them not to hold back, that I wouldn’t be offended, that I’d heard them all before.”
He continued, “There is a belief—and there is some truth to this—that health plans cause fragmentation in the health care system, that they tend to get between patients and their clinicians, that they’re profit-seeking, that they don’t promote quality care, and that they are opponents of reform. I want to try to unpack that a bit, to help students better understand the role that health plans play and offer examples from my own experience and from some guest lecturers. The goal is for students to hear a different view of health plans, to understand that they are a heterogeneous group of organizations and that—at least in the case of a not-for-profit plan like Blue Cross—that health plans can really have a community mission.”
One of the case studies in the course focuses on the role that Blue Cross and its foundation played in leading the effort to expand health care coverage in Massachusetts in the early 2000s, which ultimately led to the state’s health reform law in 2006. That law served as the model for the Affordable Care Act. “A lot of groups played a role in that effort, but it’s not a stretch to say that without the active involvement of Blue Cross and its foundation, that law may never have passed,” Dreyfus said. “And the fact that that law passed and was working gave President Obama and congressional leaders confidence that it could work at the national level.”
The course’s guest speakers include Todd Park, co-founder of Devoted Health, a company focused on making health care easier, more affordable, and higher quality for seniors, and Dana Safran, SM ’88, SD ’93, president & CEO of the National Quality Forum and former BCBSMA executive, and an expert in measuring health care quality.
Balancing private and public
Dreyfus also wants to explore with students what an optimal health care system in the U.S. might look like. He noted that many countries use a mix of private and government-sponsored care. “One critical question is: What is the proper balance between the role of government and the private sector, and regulation versus innovation? I believe in both,” Dreyfus said. “Some of the greatest innovations in health care have come from the private sector, including health plans, researchers, and tech companies. But we need broad government oversight too.”
What troubles Dreyfus most about the current U.S. health care system are disparities in care—especially for people of color, but also for people with disabilities, members of the LGBTQ+ community, immigrants, and others—and high costs. “The rule of thumb we were taught was that you should devote about 25% of your income to housing,” said Dreyfus. “But no one said anything about devoting another 25% to your health care or your health insurance. Those of us who are lucky enough to work for employers who offer comprehensive coverage do not feel the financial pressure. But there are still people in the U.S.—tens of millions—who have no insurance. There are others who have insurance, but who have to pay such high co-pays, deductibles, or co-insurance that it doesn’t feel like insurance to them.”
He added, “We already pay more than any nation in the world for our health care, but we have worse outcomes than most western democracies. It’s deeply troubling.”
Dreyfus hopes his class will spur students to think about how they can be change agents to address these daunting issues in health care, whether from within the system, as he did, or by putting pressure on it from the outside. “The health care system can be fragmented, scary, and bewildering, and when we are sick, we feel most vulnerable,” said Dreyfus. “What we want is a health care system that’s stable, equitable, coordinated, and affordable.”
photo: Salif Mangane
