Editors’ Note

Prior to assuming her current position with Empire Blue Cross Blue Shield in May 2007, Jill Hummel worked for UnitedHealthcare for six years in a variety of capacities including, most recently, as the Northeast Regional Vice President for Network Management. She also served as Vice President for Hospital Network Management for UnitedHealth Networks and, before that, as Chief Operating Officer for UnitedHealthcare of the Midwest, Inc. The recipient of a law degree from Washington University and a BA degree from the University of Rochester, Hummel spent 17 years as a practicing attorney specializing in health care law before moving into a non-legal role.

Company Brief

Empire Blue Cross Blue Shield (www.empireblue.com), the largest health insurer in New York State based on its PPO and HMO membership of over five million, is a subsidiary of WellPoint, Inc. Empire Blue Cross Blue Shield is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association.

What does the Health Care Management unit of Empire Blue Cross Blue Shield do?

The Health Care Management unit is responsible for the total cost of health care. This means that through our contracting activities we manage our network of hospitals, physicians, and other health care providers. It also means that we focus on improving the health and well-being of our members by promoting the best outcomes through programs designed to ensure that they receive the right care, in the right place, and at the right time. As an example, we just launched a new case management program that focuses on members with catastrophic conditions. We interact with those members in the hospital to make sure that they have the appropriate services that they need at the time of discharge to increase the likelihood of a successful discharge rather than one that ends with a readmission to the hospital.

In the health care sector, services often sound very similar from company to company. Is it challenging to differentiate in such a crowded market?

Yes, it can be challenging. But I believe Empire has done a good job distinguishing itself as a member of the Wellpoint family, with access to the programs, resources, and other benefits that come with being a part of a large national company, but not losing sight of the fact that health care is local. This means that the way that we interact with the provider community is more collaborative. We can take that approach because decisions are made here in the local market by people living and working in the market. Ultimately, this collaboration benefits our customers through the network stability, discounts, and programs we are able to deliver.

In addition, we have been careful to coordinate the efforts of the medical management with contracting functions. In many companies, the people who do the contracting work are separate from the people who manage the care. We recognize that the total cost of care is not just comprised of the cost of each unit of service, or the unit cost, but is also a reflection of the number of units delivered, or the utilization. Because my team has accountability for both pieces, we’re constantly thinking about how to integrate them in the contracts that we enter into with physicians, hospitals, and other health care providers. We ensure that our contracts and payment methodologies support our medical management philosophy rather than create conflicting incentives. This enables us to move beyond a focus on discounts to a focus on contract arrangements, such as our pay-for-performance programs, which support the overall quality and affordability of care.

Do you think there’s a good understanding of the types of programs you offer, and the advances being made when it comes to customer care?

The question is not only whether others understand the types of programs we offer but also whether these programs meet customer needs. In this regard, our CEO, Angela Braly, has been traveling the country and meeting with employer and union customers to promote a better understanding about our offerings but, more importantly, listening to them to see how we can do a better job at communicating and responding to their needs. Again, the focus is on the customers and their needs and how what we offer today, or may offer tomorrow, helps them provide affordable health coverage that enhances the health and well-being of their beneficiaries. We recognize the opportunity to continually improve how we communicate our programs in order to simplify the customers’ experience.

What is your approach to diversity? Do you feel there are strong opportunities for women to grow in this industry?

We are very interested in diversity, particularly in the New York market. New York itself is so diverse that we feel it’s important that our workforce reflects that diversity. The fact is the health care field is filled with women executives. About half of my direct reports at the director level are women. WellPoint’s CEO and several members of WellPoint’s executive leadership team are women. I think that demonstrates that there are great opportunities for women within the health care field. Our challenge is to continue to provide those opportunities for women while also ensuring that we provide those same opportunities to all groups so that our own workforce better reflects the diversity that makes New York great.

Looking ahead a year or two, what are your key priorities?

Our key priority tomorrow will be the same as our key priority today: We are focused on the customer. The first of WellPoint’s five core values is, Customer First. Within the Health Care Management area, that means ensuring, through our contracting efforts and innovative programs, that our customers have access to affordable, high-quality health care. On a deeper level, it means continuing to work together with other stakeholders to raise the bar for our customers – to improve health care quality, service, outcomes, and affordability.