A Discussion with Dr. Steve Udvarhelyi, CEO and President of Blue Cross and Blue Shield of Louisiana on COVID-19

March 2020

Dr. Steve Udvarhelyi, President and CEO of Blue Cross and Blue Shield of Louisiana. Dr. Udvarhelyi is a boardcertified internist with more than 25 years of experience in the health insurance industry. Prior to joining Blue Cross and Blue Shield of Louisiana, Dr. Udvarhelyi was Executive Vice President of Health Services and Chief Strategy Officer of Independence Blue Cross in Pennsylvania, and has held various roles with Prudential Healthcare.

Both as a physician and as a Blue Health Plan CEO, give us your perspectives on where we are today, Friday, March 27th, in the healthcare crisis and the response to COVID-19 generally.

I think different areas of the country are in different places, but overall, we continue to see the spread of the COVID19 infection on a national basis. The United States now has the most cases in the world. We've surpassed China. Gratefully, we don't have the highest number of deaths yet, but we are seeing a continued spread of the virus in highly localized areas around the country. Obviously for us in Louisiana, New Orleans is an area that has a very high per capita rate of the infection, and unfortunately one of the highest per capita death rates.

What's challenging about this is that it really accelerates at a very fast rate, and it's probably accelerating beyond our capacity to test. So, I think what I would say to everybody is we are still in the process of this virus and this infection spreading, which is why social distancing and the measures to limit contact that can lead to spread of the virus are so important. And if you live in an area that does not yet have a high number of cases, the best time to do the social distancing is before you have really high rates in your community. What I would say is we're still on the rise and I think as many elected officials have said, certainly our governor, the mayors of our cities here in Louisiana, while it's troubling today, we're going to continue to see it get worse. I think that the real critical issue for all of us is when does the number of cases start to overwhelm our healthcare delivery system? And we're beginning to see that in selected areas.

Given that Louisiana has been particularly affected, what operational challenges have arisen as the Blue Cross and Blue Shield of Louisiana team looks to address the needs of your constituents, including your members, your employers, as well as your own employees?

That's a great question. At Blue Cross and Blue Shield of Louisiana, we're responding to the pandemic really from three lenses. First, we're responding as an employer. Like many companies have, we manage our own employees. Second, as a health insurer, we're there to meet the needs of our members and work with our network of providers. Lastly, in one market in Louisiana, the Monroe Market, we actually have as part of our family of companies, a medical group and a small hospital. So, we're looking at it as a provider as well. As an employer, our initial objective was to try to move as many of our employees to work remotely as possible. The reason that's important is in a headquarter building where we had almost 2,200 people coming in and out every day, if we have someone who's been diagnosed with the COVID-19 infection walking around the workplace, they will likely have exposed a great number of people and not only will they need to be quarantined, but we want to make sure they don't come down with the infection. We're delighted to say that in the course of one week, we moved almost 2,000 people out of the building to work remotely, a remarkable achievement by our IT team, and we were able to do that ahead of the stay at home mandate that the governor announced.

Fortunately, today, while we've had a few of our employees exposed to people with COVID-19, none of our workforce has been infected. That's the other challenge as an employer is you worry that if the virus spreads through a workplace, and what we know about the virus, I'll just say, is that it tends to spread most rapidly in confined settings. That's why nursing homes are such a challenge. It also seems to cluster in families in their own homes, and the same thing could happen in a workspace. We've seen it in hospitals, actually.Commentaries Banker Commentary by Mike

As a health insurer, what we've done is really tried to help both members and our providers. For our members, we've announced, like others have, that we're going to waive cost sharing for COVID-19 testing. We've greatly expanded access to telehealth, and to the extent possible we're trying to do that with no cost sharing. We worked with our physicians and hospitals to expand their capacity to provide services on a telehealth basis, and it's not just physicians. We've worked with therapists and behavioral health providers to do that, and have ramped that up significantly so the people can get the care they need without having to travel and be exposed to people that are coming in for acute care.

Lastly, as a provider, we only have a small footprint there. We, like others, are seeing the biggest challenge in shortages of personal protective equipment, and in some of our own workforce becoming ill as they treat patients.

I think we've done a good job at managing all of those, but this is an evolving, very fluid situation, and like others, what we're doing is managing this as a crisis with a very formal crisis management process. One of the benefits of living in Louisiana, since we have a lot of hurricanes here, is we do have a good crisis management process that we're able to tap into that allows us to address things rapidly and respond.

With regard to your hospital and physician provider network, which are undoubtedly experiencing strain as in other parts of the country, what is Blue Cross and Blue Shield of Louisiana doing to provide support, for your membership, and how can Blue Cross and Blue Shield of Louisiana address those needs?

The needs vary substantially by whether it is a hospital or a physician group. It also depends on whether it's an urban area or a rural area. So, the first thing we're doing is listening and trying to meet their needs, which do vary. Going back to the comment we just made, they all need help with expanding their ability to provide services to their patients remotely, by telehealth, etc. We've also relaxed some of the criteria and the federal government has responded that way, too. Some non-HIPAA-compliant devices are now being allowed to be used for telehealth services.

We're allowing providers to get paid for that expanded footprint of services, and including in some cases just telephone calls if they don't have a video capacity available. And that's important for them, so that they can continue to get paid while providing services during this pandemic. We've relaxed some of the normal protocols such as prior authorization. We've expanded access to medications for our members and relaxed prior authorization requirements there. From an administrative standpoint to try to make it easier for hospitals and physicians that are becoming increasingly burdened with caring for COVID-19 patients.

I think the financial support from the federal government is important to the provider community, and I think the providers are worried about cashflow and so we're trying to address that. It is not a one size fits all, but we're also worried as an insurer about making sure that our financial strength is used to take care of the healthcare needs of our members when those needs explode in a time of crisis. We're watching that carefully and trying to balance the needs of a lot of folks. We hope the stimulus money also comes down to businesses to allow them to have their employees stay employed, maintain their health coverage, so that we can then in turn pass that money along to the providers who are taking care of those people.

Are there other areas in which you feel the stimulus package will help particularly, and are there areas at this time you feel may require additional support by either federal and/or state governments?

The stimulus package is important. We don't yet know how quickly those funds can be made available to both the states and the provider community that's going to need them, as well as the business community. There may need to be some things that all of us try to do to bridge to that point. I think federal support for the provider community in terms of protective equipment, supplies, ventilators, and assistance in setting up temporary hospitals, at least in select markets, is going to be critically important. We're seeing that out of New York, we're seeing that now in New Orleans. I think we're going to see that in other major cities.

When Governor Cuomo said, "This is where we are now, but this is where the rest of the country is going to be later," I think it sent a pretty clear warning signal that we all need to be prepared for things to get strained in other parts of the country. And our former secretary of the Department of Health was interviewed this morning on the Today Show, and correctly said that what's very different about this crisis compared to other things that we deal with like hurricanes is that the whole country is being impacted simultaneously. So, unlike other events, weather events, where people from a non-impacted part of the country can come to the aid of an area that's impacted, we don't have that flexibility in this crisis, which makes it very different.

But I do think in the supplies, protective equipment and particularly for our healthcare workers, if our healthcare workforce is substantially diminished because they become ill with COVID-19, that's just going to exacerbate the situation that much further.

Are there other things that Blue Cross and Blue Shield of Louisiana is doing to engage and interact with members in this time? How do you view Blue Cross and Blue Shield of Louisiana's role in engaging with the broader Louisiana population outside of your own membership?

First and foremost, we want to make sure that we're communicating frequently and accurately with our members, with our providers about what is going on and how they can continue to depend on us as they must help support their healthcare needs.

There's a lot of misinformation potentially out there, and so whether it's CDC recommendations or other recommendations from healthcare professionals, we're trying to point people to accurate and correct information, trying to get them guided to where the best care delivery could be for their issues and remind us all that while obviously COVID-19 care is front and center, there are a lot of people with ongoing illnesses that do need care. There are people that still are having urgent issues that need to be attended to.

We're trying to make sure that we provide that guidance where we can, and we're not looking to be necessarily the preferred source of information on all things, but we're working cooperatively with others. The one area where I would say that we lent a hand to the state is that we have a very advanced analytics department in our company. We've been able to use that to help the Louisiana Department of Health understand where people are going into hospitals; what the diagnoses that they're going in for are; and that really helps them from a planning perspective in understanding and maybe anticipating where the virus is going and what kind of support is needed in different areas around the state. We're happy to lend them that capacity during this crisis.

How is Blue Cross and Blue Shield of Louisiana working with state and local governments and regulators, and how can government and regulators support Blue Cross and Blue Shield of Louisiana?

I think it varies depending on the state, the issues will vary a little bit state to state. We have a very good relationship with our state government. We have a good relationship with the governor's office, with the Department of Health and with our Department of Insurance. We're staying in touch with all those state government departments and understanding what we can do to be helpful and provide information. And in some cases, we provide some guidance that maybe some things that may seem to be beneficial may have some unintended consequences that are actually not helpful in the long run, and you try to find some guidance there as well.

Our biggest concern as an industry is that we're not put into a financial squeeze by well-intended efforts to provide people with coverage, etc., that would take away our reserves for other things that they were originally intended for. So we're trying to be cooperative in that nature, meet the needs of our members, but also make sure that we're being careful custodians of the resources that are there for our customers and our members when they need it.

At this early stage in the crisis, can you, as a health plan CEO and physician, assess any lessons learned and changes that you would hope to see implemented for a response to future healthcare crises?

That's a great question. In many cases, it's a little too early to look back on lessons learned. I think if you listen to Dr. Fauci from the NIH, maybe all of us realize now that we wish we'd responded sooner to the virus than we did. It’s hard to know whether we would have made different decisions with the information that we had at the time, but I think there will be a time when we'll look back and share information. I'm hoping that's not too far off. But right now, it's a little too early to really understand exactly how we could've managed this in a different way for a better outcome.

And by the way, we're not alone in this country. I think the whole world will learn from this in a fundamental different way. There are some early silver linings on this. First, I think there will be an enduring impact in terms of using telehealth and telemedicine to care for people. This crisis has shown us that that's important, and that moving forward the delivery system will probably migrate to a much broader use of telemedicine capabilities, which is probably a good thing for all of us. But we'll have an opportunity to do that in a more thoughtful and structured way at the end of the crisis.

As employers, I think we've all learned that we can work remotely at scale much more effectively than we would have thought, and that's going to have some enduring impacts on how we work and where we work. So those are two things I think that we've learned is we've responded, but the broader lessons I think are yet to come.

Join Dr. Steve Udvarhelyi, CEO & President of Blue Cross and Blue Shield of Louisiana and Mike Elizondo, Director at Cain Brothers in a discussion of the COVID-19 pandemic, its impact on the healthcare sector and how Blue Cross and Blue Shield of Louisiana is responding.

Dr. I. Steven UdvarhelyiDr. Steven Udvarhelyi is president and chief executive officer of Blue Cross and Blue Shield of Louisiana. He is a board-certified internist with more than 25 years of experience in the health insurance industry. Prior to joining Blue Cross and Blue Shield of Louisiana, Dr. Udvarhelyi served as the executive vice president of health services and chief strategy officer of Independence Blue Cross in Pennsylvania, and has held various roles with Prudential Health Care as well.

Dr. Udvarhelyi serves on the boards of the Blue Cross and Blue Shield Association and the Baton Rouge Area Chamber of Commerce. He also serves on the Committee of 100 and the Business Council of New Orleans. He is a past board member of NCQA, NaviNet and the Franklin Institute and has served on Institute of Medicine roundtables and committees.

Udvarhelyi received an A.B. degree from Harvard College, an M.D. degree from the Johns Hopkins University School of Medicine and a Master of Science degree in health services administration from the Harvard School of Public Health. Prior to his career in the managed care and health insurance industry, Udvarhelyi was a faculty member at Harvard Medical School with a focus on health services research.

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