Hello, everyone. This is Jacob Emerson with the
Becker's Pay Your Issues podcast.
Thrilled today to be joined by doctor Steve
Friedhoff, who is the senior vice president of
health care services at Blue Cross and Blue
Shield of North Carolina. Doctor Friedhoff, thank you
so much for taking the time to be
with me on the podcast today.
My pleasure. Thank you, Jacob. Yeah. Absolutely. And
before we dive into everything we wanna talk
with you about, Steve, can you tell us
a little bit more about yourself, your background
in health care, and what it is that
you're doing today at Blue Cross North Carolina.
Sure. Happy to. So I'm a family physician
by backgrounds. I practiced for about twenty years,
either on a full time or a part
time basis
in a combination of community practices and academic
practice. I was the medical director of a
family medicine residency program at one point.
I've had a fair amount of experience in
hospice and palliative care and,
joined Blue Cross of North Carolina about four
almost four years ago.
And my areas of responsibility as senior vice
president of health care services
include all things related to medical care management,
behavioral health,
pharmacy,
contracting with our provider network, including all of
our value based care programs,
our quality programs, including
stars and risk adjustment,
payment integrity and accuracy, and our affordability programs.
So it's a pretty broad focus, but, one
that very much
remains, focused on affordability,
access to health care, and quality outcomes.
Fantastic. Well, I appreciate that overview, Steve.
The first thing we wanted to talk with
you about is Blue Cross of North Carolina
being instrumental in partnering with the UNC School
of Medicine to address
North Carolina's health care provider shortage
by training veterans for medical careers. So talk
to us a little bit about this initiative.
How has it evolved over the years, and
and what's the impact that you've seen in
terms of filling those critical gaps in care
in in rural and
underserved areas of your state?
Sure. Happy to. UNC has been a great
partner to us on on a number of
different levels.
But this specific partnership with the UNC School
of Medicine, as you indicated,
was to develop a physician assistant program
that was really trying to address two different
problems with a single strategy.
First, you know, we know there's a statewide
gap in health care providers,
in North Carolina, like in many, many other
states,
particularly in our more rural areas.
And then the the second is helping returning
veterans,
with medical training
to define careers in civilian health care across,
North Carolina.
So this program was initially created in 2012.
I believe the first class graduated in 2015.
So this is the, the tenth anniversary.
And the idea,
was to recruit nontraditional
students
like veterans or other North Carolina residents who
are the, over the age of 26.
So students in this program
train for careers,
in fields ranging from primary care to orthopedics,
cardiology,
emergency care, and and mental health. And, ultimately,
they can choose to practice,
wherever they they want. But the program is
designed to create a pipeline of providers,
for medical
medical deserts all across North Carolina.
And since in inception in that first graduating
class of twenty fifteen, we've had a 40
physician assistants who graduated from the UNC physician
assistance program
and gone on to careers throughout the state
in the OR, the ER, and a variety
of different clinic settings.
Wow. I mean, that's an amazing number that
you just shared, and it sounds like this
is a very impactful
program within the states.
I wanted to ask though, you know, many
states, including North Carolina, as you know, they
don't recognize military medical credentials
despite the vast experience that military medics gain
when they're in the service.
So how do you envision expanding this partnership
to further recognize and leverage the skills that
these veterans have within the civilian health care
system?
Yeah. This a number of years ago in
a different role, this was actually a pretty
significant
moment, for me.
In in a prior role, I I worked
near a very, very large,
military
base, and we recruited a significant
number of
veterans,
from that that population.
And to your point, I never realized
that
there was no crosswalk between
military medical credentials
and
in civilian life. And, you know, one story
in particular that just I've hit home with
me and really carried with me to this
day is I interviewed and ultimately hired an
individual
who is the only medic
on a destroyer.
And,
you know, as part of that role, I
mean, fortunately, it
it it was less about, you know, treating
injuries and anything related to combat, but more
about, you know, having hundreds or thousands of
individuals
in a very isolated place where you didn't
have access to
specialists or, you know, lots of other facilities.
And this individual is responsible for taking care
of
all the different illnesses and accidents and injuries
that could happen in any small to medium
sized population.
Yet when he left the service,
none of that training, none of that mattered.
So at the end of the day, you
know, he had tremendous
clinical experience, and we ultimately,
found him a role that was a great
fit where we could leverage that experience,
but in a way that did not require
a a license.
But that that was just such an eye
opener to me. And North Carolina has several
military bases as as you know, and the
fourth largest military population in the country. And
about 20,000 active military members transition to civilian
life every year.
And, you know, we know from the UNC
PA programs,
you know, a number of us from our
own personal experience that, you know, veterans bring
an incredible amount of, you know, discipline, resourcefulness,
commitment, and compassion to their roles.
And all of these characteristics,
you know, have the potential to make for
an exceptional
health care provider.
So helping them move into civilian health care
is is really a win for our state.
We get some great medical professionals and we
improve access to care and we obviously help
to further, you know, individuals,
careers.
So we we do support veterans and active
military service members and their families across our
company in a number of additional ways at
Blue Cross North Carolina.
In addition to the PA program, we also
participate in the SkillBridge program,
which provides soldiers with, civilian work experience during
the last six months of their military career
to help them with that transition,
out of the service.
We also participate in the Department of Defense's
military spouse program,
and that helps connect military spouses who often
have to relocate
you know, to find, meaningful careers in their
new locations.
And we also have a very, very active
employee network called VetNet
that's dedicated to uplifting,
our very proud local community of veteran employees
to increase their sense of belonging at Blue
Cross of North Carolina. So it's through all
these different initiatives that we really try to
help leverage the the skills of veterans and
all that they can bring to North Carolina.
Absolutely. And that was such a great anecdote
that you shared about about the medic. So
I appreciate that, Steve. And, really, it's great
that you're able to to turn their clinical
expertise,
into a benefit for the wider health care
system.
If we were taking a step back, can
you explain why Blue Cross North Carolina has
invested so much in supporting the health care
workforce in the state? I know you briefly
touched on this, but but why is this
such an important,
move for the company and and any other
steps you'd share in terms of how Blue
Cross is supporting providers across North Carolina?
Sure. Well, you know, Blue Cross in North
Carolina as a single state Blue Cross plan,
we're committed to improving the health care for
all of North Carolinians
wherever they live. And and, frankly,
you know, whether they insured are insured by
Blue Cross of North Carolina today,
or not.
And right now, we know that nearly 3,000,000
people in North Carolina live in places that
are deemed health professional shortage areas,
Meaning, it's not just about not having enough
physicians, there's not enough nurses or other providers
to meet demands, including
physicians.
And this is particularly true in many of
our rural communities
and where it's particularly difficult to attract and
retain health care professionals in some of those
settings. So that's one of the reasons we've
made significant investments in the health care workforce.
It's one of the more impactful ways we
can keep communities healthy, keep health expenses down,
and really try to take more and more
of this further upstream.
And colleges and universities,
you know, they play a critical role in
training this next generation.
So it's establishing
those kinds of partnerships where we really feel
like we can help make a difference and
move the needle in in North Carolina.
So I'll highlight a couple of our key
investments.
One of them through, again, through UNC is
the School of Medicine's Primary Care Rural Advancement
Program.
This investment has made a real difference in
Rockingham County. It's
increasing,
patient centered primary care. It's recruiting more residents
to enter the profession in Rockingham County and
neighboring counties, and it's provided,
many different opportunities for students studying medicine, nursing,
pharmacy, and other health professions to better prepare
them for practice in a in a rural
community.
Another example is the Winston Salem State University's
division of nursing. It's one of the top
nursing programs in the country.
And,
Winston Salem State used this funding to provide
scholarships,
expand access to care, and enhance some of
their own technology
infrastructure
to help better prepare the nurses of the
future.
Third example would be North Carolina A and
T State University School of Nursing.
This particular investment
worked toward, or excuse me, went towards scholarships,
new equipment, new technology,
all to encourage,
student development,
and addressing those nursing shortages
while providing them with access to, you know,
the most modern tools as part of their
their studies.
So,
you know, as part of what we do
to try and expand the workforce, we also
have to focus on the workforce that exists
and continue to make it a more attractive
place to practice.
And when you think about
a physician's
mindset or other providers mindsets, typically,
there are three things top of mind for
them in terms of their their goals and
how we can hopefully best support them. One
is, you know, certainly top of the list
is delivering the best possible patient outcomes.
Second is reducing their administrative burden associated with
providing that care. And third is receiving a,
you know, fair and reasonable payment for the
services that they do
provide. So we
a lot of our strategy is how we
collaborate providers
to meet these three aims and put those
kind of supports in place. And one of
the things I'm particularly proud of is something
called our Blue Premier program.
That was launched in 2019,
and it's our value based care program
with the goal of enrolling as many of
our members as possible with physicians
who are in a value based relationship with
us.
And as of today, our Blue Premier program,
every single one of our large systems in
the state,
is part of Blue Premier.
About two thirds of our primary care physicians
are part of Blue Premier as well. And
about the same percentage of our commercial and
Medicare members,
actually see a physician who is part of
Blue Premier. And the whole idea is to,
provide incentives and also hold doctors and hospitals
accountable
for meeting, certainly first and foremost, quality measures,
but also
affordability measures.
And making their payments based on,
improving care delivery rather than just the simple
number of tests and procedures,
performs.
And by doing so, we reduce the number
of unnecessary ER visits. We reduce the number
of
unnecessary hospitalizations
or rehospitalizations
and improve
the health of our members.
And one of the things that, really sets
this apart is that
any of the cost savings we share significantly
with with physicians and other providers who are
part of Blue Premier.
So since it's launched,
we have saved over $800,000,000
in medical medical costs.
And about two thirds of that actually goes
directly back to physicians as an incentive payment.
The other third goes to keep our rates
lower to help,
make health care more affordable for all the
people in in in North Carolina.
So,
you know, I think that's that's one of
the ways we have really tried to work
with providers.
Another example of that is to help free
them up from some of the administrative
burden.
And one of the ways we have done
that was by entering into a joint venture
in 2021
to form an an organization called Allo.
And the whole idea behind Allo was to
make it a,
make physician independence
something that is
financially viable
and is administratively
unburdensome
as possible. So what Allo does is provide
administrative support,
high-tech tools,
infrastructure,
and similar that reduce the administrative burden on
physicians,
allow them to focus on
taking care of patients, which is what most
of them signed up, you know, to do
anyway in the first place,
and,
allow them to remain independent
in a way that is
economically
viable and also viable from a work life
balance kind of, perspective.
So, you know, I guess maybe the last
thing I'll I'll I'll say on this topic
is that you you may have heard that
we have recently modernized our ninety two year
old structure and announced the creation of Curacor
Solutions,
which is a North Carolina based not for
profit parent company.
And what this organization
does or this reorganization
does is allows Blue Cross of North Carolina
to continue to make investments in
organizations like Allo
to deliver on making health care more affordable,
accessible, and easier to navigate
while still remaining a not for profit mission
driven company.
And,
you know, certainly not changing anything that is
fundamental to
Blue Cross of North Carolina
as a more traditional payer within the state.
Certainly. Well, clearly, so much impactful work going
on at Blue Cross of North Carolina. So
appreciate you detailing everything that's happening across the
enterprise for us, Steve.
Before we go, what else are we missing?
We've got a lot of other health plan
leaders listening in from all over the country.
Any final bits of advice or or final
thoughts that you wanna share with them?
Well, I think a lot of what I've
spoken about, you know, without well, maybe saying
the actual phrase is, you know, we're trying
to help our members continuously find the right
level of care at the right time, at
the right place, and hopefully for for the
right price at the same time. But one
thing maybe I would love to touch on
just because it's something I care, you know,
very, very deeply about
is youth mental health.
You really can't go a day or a
week or longer without hearing something, reading something
about the youth mental health crisis,
in this country.
And when you hear statistics
like forty percent
of, you know, high school or similar youth
report feeling sad or hopeless,
every day, and an incredible number of
youth of that age have seriously considered
harming themselves or suicide.
It is clear we have a significant, significant
problem to address. And, you know, these are
the individuals that are next generation. They're the
next generation of adults, of parents, of of
leaders. And it's really frightening when you hear
those kinds of statistics.
So one of the areas we have really
tried to focus
on in the last few years
has been youth mental health and it's through
a couple of different,
avenues.
One I'll just touch on briefly is a
program called behavioral health total care.
And that's a program that engages the parents
of children
who we notice are either going to emergency
departments or other settings with with mental health
needs. And the whole idea there is it's
behavioral health childcare serves as a central point
of coordination
and support
for the members, the youth, their parents,
that really addresses their needs on a whole
person health
kind of basis.
Operates on the principle principles of finding a
behavioral health home
that prioritizes things like continuity of care, integrating
with other services that provide a much more
personalized approach, and really helping them get the
kind of support that meets their unique needs
and
meets them where they are.
So through this team, you know, we've have
individuals who can engage with them as care
navigators,
as peer support specialists,
and a variety of other means to ensure
that they're getting to the right
excuse me, the right providers at the right
times.
And
we're we're finding the demand for these services,
not surprisingly, has been very, very high. And
we also find that the parents,
are responding because we understand that it's very,
very challenging for them when,
you know, one of their own children has
mental health needs.
Another component of this that is very much
focused on youth behavioral health, but, is also
available to all of our insured
is a behavioral health care navigation service.
And
one of,
the things that I would say is unique
about behavioral health is that, yes, there's a
workforce
shortage.
And yes, it's always important to find the
right provider.
But unlike a lot of other specialties, the
behavioral health
relationship with a provider, whether it's a psychiatrist
or a social worker or other type of
a provider,
you know, it's it can be very intimate.
You're sharing very,
you know, closely held details of of of
your life and the person really needs to
be a good fit.
And
one of the best predictors
of
someone receiving appropriate behavioral health follow-up care is,
you know, not surprisingly,
you know, how they felt about their behavioral
health provider, whether they they clicked. So the
whole idea of our behavioral health navigators is,
first and foremost, there's no wrong front door.
Patients can self refer, a provider can refer
them, one of our own case managers can
refer them. But once our behavioral health care
navigators
are involved,
we'll not only understand what their clinical needs
are to get them to the right provider,
we also want to understand their preferences. What
are they looking for in a behavioral health
provider,
counselor, a psychiatrist?
You know, what's important to them? Is it
important for them to have a similar backgrounds
to, you know, to to to look like
them, to understand what they've gone through? And
our our care navigators,
you know, really leverage
being local to understand what our network looks
like and get them connected to the right
behavioral health provider,
help them get an appointment, make sure the
appointment occurred,
get them the follow-up they needed,
and hopefully set them on a on a
positive path. So I'm sorry. I know that
was kind of a long answer to to
your question, but, I'm just so passionate about
behavioral health in general and, you know, youth
behavioral health, specifically. So,
hope that was helpful.
Yeah. No. Absolutely. Very helpful. Your your passion
is coming through the screen, Steve. So I
appreciate you calling out this this pressing and
important issue and explaining for us how Blue
Cross of North Carolina is tackling these challenges
head on for your members and for the
wider communities that you serve. I also wanna
thank you for taking the time to sit
down with us and for sharing your insights
with our listeners. We really appreciate it.
Yeah. Thank you, Jacob. Appreciate the the time
to participate.
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