BlueCross president: Columbus operation poised for job growth

The BlueCross BlueShield of Georgia operation in Columbus is well positioned for growth whether or not the health-care insurer’s parent firm, Anthem, completes its $54 billion mega-merger with Cigna later this year, said Jeff Fusile, president of the Georgia company.

“Because this facility is performing so well and is the prototype for the rest of the country — and Cigna would be the biggest piece of growth on the horizon — there will be a lot more opportunity for us here in Columbus to hire and to grow, and to potentially look at down the road leveraging that opportunity to build a new building,” said Fusile, who took the helm of BlueCross BlueShield of Georgia about six months ago.

It was only last September that the insurance company cut the grand-opening ribbon on the sparkling new 235,000-square-foot office complex inside Muscogee Technology Park. It now employs about 1,450 at the site, with plans to have 1,750 on its payroll there by 2017. The company, which employs about 4,000 people statewide, relocated from its longtime space on Warm Springs Road, which now sits empty and is up for sale.

“By the rate we’re going with growth, I think we’ll outpace that,” Fusile, speaking of future hiring in Columbus, said in an interview Thursday at the Ledger-Enquirer’s downtown office. “We could get to 2,500 if necessary and we could expand space beyond that if we get there.”

The Columbus operation’s primary task is to process insurance claims and handle other customer service chores for its 3 million members across Georgia, but also in other states where Anthem’s insurance subsidiaries do business. The executive said the local workforce already processes more claims than any other Anthem facility in the U.S.

“It’s incredibly important,” he said of the work being done in Columbus.

A certified public accountant who joined Indianapolis-based Anthem Inc. in 2011 after spending more than two decades with PricewaterhouseCoopers and Navigant Consulting, Fusile’s job now is to manage the commercial business operations of BlueCross BlueShield of Georgia amid inevitable and what looks to be difficult change in the health-care industry.

Considered a strategic thinker in the area of health care, the executive said the “centerpiece” of his efforts out of the gate at BlueCross BlueShield of Georgia is to convince all involved — hospitals, primary-care physicians, specialists, pharmaceutical companies and laboratory operators — that the current system is not sustainable financially for consumers and patients. He pointed out that average health-care costs for a family of four are now at about $24,000, with that family earning just over $50,000 a year.

“So that’s almost half of their gross income,” he said. “Sometimes that’s paid by the employer, sometimes it’s paid by the government, and sometimes it’s paid by the family ... and it’s going up by 5 and 6 percent, and people’s pay isn’t going up that fast.”

Something has to change, said Fusile, who points to a care-delivery model known as “Patient-Centered Medical Home,” which emphasizes better use of primary-care doctors to offer more personalized and constant care of patients through their lifetimes. That includes advocating for healthier lifestyles and perhaps suggesting more-costly and invasive treatment such as surgery as a last resort.

The executive acknowledges it’s not always an easy sell, with some health-care providers either resistant to change in general or fearful of seeing their own earning power cut in the process. He said BlueCross BlueShield is in favor of paying primary-care physicians higher compensation to deliver a personalized, wellness-focused approach.

“Today they’re the lowest comped (compensated) clinician out there,” he said. “We spend about 4 percent of our total medical dollars on the primary-care physicians, yet they control about 72 percent of our cost.”

Other elements of the push to help control costs include the use of computers, smartphones and tablets to connect patients with doctors in which they can see their faces and hear them speak and ask questions. The effort also includes convincing primary-care providers to extend hours into evenings and remain open on weekends, even if it’s with reduced staffing.

About a month ago, Fusile said, BlueCross installed a live health kiosk that allows its Columbus staffers to sit down in private — perhaps at lunchtime — hit a button, select from a list of doctors and interact with one of them via a computer screen. A stethoscope, ear scope, thermometer and blood-pressure equipment are on hand in case the physician would like the person to check their heartbeat or other vital signs.

“I will tell you as we meet with the providers that’s how I start every conversation,” Fusile said of talks with medical providers. “Let’s agree that the $24,000 can’t keep going up at the rate that it’s going up, which means you need to make less money per person and so do we. That doesn’t mean we need to make less money. But if we can figure out how to get that (insurance cost) number down and at least not going up so fast, we’ll have more customers. We’ll serve more people, we’ll do more good in the community and we’ll create more jobs because people can afford to hire more people” instead of spending so much on medical care.

The effort to get a grip on spiraling health-care costs comes with the Affordable Care Act causing issues with some insurance company participants. UnitedHealth recently said it will no longer sell insurance through the health-care exchange in Georgia next year, while Aetna, Humana and Cigna have not made a decision. A number of insurers have found it difficult to turn a profit due to more consumers already with health issues purchasing plans, while fewer healthier younger people — who would help offset costs — opt not to use the federally mandated coverage.

Fusile said BlueCross and BlueShield of Georgia is “committed” to remaining in the state exchange. He said some insurers initially entered the market with lower rates than were needed to be profitable, although it did bring them a high number of customers. But those insurers now are reconsidering the cost of doing business, with some inevitably calling it quits in several states. BlueCross, he said, decided to price appropriately from the start, which did have an impact on growth, but has allowed it to maintain a profit overall.

“I would say in the first year we made some money,” he said. “In the next year, we probably were pretty close to break even. As these models are maturing, things are normalizing or stabilizing. But we’re committed to it and we’re excited about where it’s going.”

Over the long haul, the executive said, his company will begin to see “reasonable” growth. While BlueCross has about 3 million members in Georgia now, he said it will likely rise to between 3.1 million and 3.2 million within the next year or so.

Fusile doesn’t see the Affordable Care Act going away, however, even after the upcoming presidential and congressional elections. There may be some “tweaking” of the program, he said, but don’t look for the government to cut people off of the health-care coverage they have become accustomed to receiving.

“People will need health care,” he said. “There are a lot of things in this program that are working. If you have a pre-existing condition, you’re getting covered. We’re starting to make the comparability of plans a little easier for people to understand — silver, platinum, gold. It’s not perfect, but better. And you can go online and shop. You don’t have to go somewhere and hope you’re getting the best deal. All of those things are positive.”

As for BlueCross BlueShield Georgia specifically, Fusile said the company has good networks and providers in them. But its interaction with providers and payment systems needs to change to help reduce the “angst” in the industry so that the needed change can take place. Part of that process is a branding effort called “Together Works,” which hopes to foster some sort of unity between the insurance companies, hospitals, doctors and other players in the industry.

“You just don’t want this animosity where everybody’s pointing a finger at somebody else and nobody’s focused on taking care of the person,” he said.

This story was originally published April 18, 2016 at 2:40 PM with the headline "BlueCross president: Columbus operation poised for job growth."