Why Health Insurance Matters

In this episode of Community Check-In, Dr. Steven Cohen, Chief Medical Officer for Excellus Blue Cross Blue Shield, discusses the importance of health insurance and how it contributes to overall health and well-being. The episode explores how health insurance not only protects individuals and families from high healthcare costs, but also plays a crucial role in promoting better health outcomes and access to care.

Episode Transcript

(00:03):
Welcome to excel Us Blue Cross BlueShields Community check In. Each week we
cover a specific topic featuring excel UsBlue Cross Blue Shield experts. You'll get
to know our team as we discussthe latest in healthcare, health education,
and community health. Find us atexcel Us BCBS dot com and follow on

(00:25):
Instagram and Facebook. I'm Jeldamonico andwelcome to this week's Community check In.
You've heard the old adage insurance,you have it, you hope you never
have to use it, But whatis it really all about? What is
it for and how is it beneficial? We have with us today at expert
on that subject is doctor Stephen Cohen. He is VP of Medical Affairs for

(00:49):
excel Us Blue Cross Blue Shield He'salso a primary care physician and a lifelong
resident of Upstate New York and boardcertified in Internal medicine, member of the
Monroe County Medicals Society, Doctor Cohen, Welcome to the Community check In.
Great to be here, Joe,Thank you. We spend a lot of
time doctor on this show talking aboutall of the many ways that we can

(01:11):
help ourselves stay healthy, eating right, moving more, managing our stress levels,
staying on top of those really criticalscreenings. But today we're going to
tackle a topic that's kind of,I think, a question that a lot
of people might have and one theymight not think of as really being a
part of their healthcare routine, andthat is why should I have health insurance?

(01:34):
It's a big topic to unpack,but let's get started. Okay,
Well, you're right, Joe.You know, we do talk a lot
about all the things we need todo to keep our bodies healthy, and
you just mentioned some of the mostimportant ones. But still, even if
you're doing all those things, therereally is a key ingredient that's missing,
and that's protection. That's the protectionthat having health insurance brings you. And

(01:55):
there's two main reasons why this isso important. The first one, when
we hear this the most, justto protect you and your family from the
high costs of healthcare. Without healthinsurance, you really might have to pay
out of pocket for everything from yourmedications, a visit to the doctor for
a strep throat for instance, toa lengthy stay in the hospital if you

(02:15):
are unlucky and have a major illnessor injury, and boy, those costs
can really be significant. You know. Without health insurance, things like serious
cancer diagnosis, a car accident,or even a broken leg can cost you
just thousands of dollars out of pocket, and really uninsured members of our communities

(02:36):
are are exposed to these huge medicalbills, which, as you can imagine,
drives just incredible stress. You know. Equally important is that health insurance
is directly linked to overall health andoverall better health enrollment and a health insurance
products supports the health and well beingof you as an individual and also of

(02:58):
everyone in your community. You know, there's a lot of studies out there.
They talk about things like improving accessto care supporting what we call positive
health outcomes, and those include thingslike an individual's sense of their own health
and well being. You know,studies really do confirm that this incentivizes the
appropriate use of healthcare resources and reducesfinancial strain on individuals and families, and

(03:23):
really puts people in a position wherethey don't have to start making those hard
choices. Do I choose those routinescreenings, having a doctor, seeing a
doctor, having a procedure when itis medically necessary, and having to balance
those things against how do I keepmy lights on, my heat on,
and my kids fed? Absolutely youknow, the opportunity for you to know

(03:46):
that you can go get your mammogramwhen you need that, you can get
coal cancer screening, those types ofthings which are covered and almost exclusively in
fall. You really do have accessto things where you will not have costs
that you have to bear outside ofwhatever your normal contribution to a premium might
be. For instance, I lovewhere this conversation is going to go because

(04:08):
we're going to talk about insurance andframe it in a way that I don't
think many people have had this conversationor this type of conversation before. So
let's circle back around to something youtalked about just a moment ago, how
health insurance or how having it canimprove health and well being not only for
those who have the coverage, butfor the wider community in general. We
like to expand that conversation out sure, you know. The American Hospital Association,

(04:32):
as an example, has issued areport that shows that in states where
health insurance is widely available, forexample, through low or no cost Medicaid
programs, members and their families arefour to five times more likely to have
regular sources of getting care, andthere are two to four more times more
likely to receive preventive care services thanindividuals who are without insurance coverage. I

(04:58):
think it's important to understand and thatyou insurance is something which whether we have
one policy with one company or another, we all bear that cost. We
bear that in sometimes higher taxes forMedicaid and other safety net programs, and
that the more people are getting theneeded care, the more people that are
getting their necessary preventive care. Thathelps to blunt the constant growth and health

(05:21):
insurance costs. And also along withthese most individuals, but not all,
but a large number of proportion ofmembers are more likely to have a personal
doctor. They're so called primary caredoctor, primary care provider, and that
individual is really key to your ongoinghealth and care. Additional studies have also

(05:42):
shown that in states where affordable coverageis available, people will access preventive care,
seek out and seek out treatments forthings like heart disease, and even
quit smoking. There's also some datathat we see now in the states that
have unfortunately less affordable coverage and lessaccess to medicate and what we call safety
net health insurance programs, and unfortunatelyin those states, they do have higher

(06:08):
rates of chronic disease such as smoking, obesity, high blood pressure, heart
disease, etc. And it endsup having earlier death statistics in those states
compared to states that have more affordableand greater access. So it would seem
then, based on some of thedata and available research that's been out there

(06:30):
right now, that's one of thereasons maybe why insurance and or tying it
to a personal care doctor or aprimary care physician can be such an important
sort of one two punch. Onewould really help bolster and prop up the
other. Absolutely absolutely, And youknow, we know we're talking a little
bit about some of the studies thatare out there, but again, if

(06:51):
you have insurance, it generally meansyou're more likely to see a primary care
physician and to have a designated individual, someone who is the manager of the
team, the quarterback, who reallyhelps to coordinate all that care for you.
Now, early in my career,I serve as a primary care doctor
for about twenty years, and Ican tell you it's a very important role.

(07:13):
And the primary care physicians in ourcommunities and across the country, they
take their responsibilities and roles very veryseriously. You know. Having worked in
both sides of the medical care world, you know, I've seen countless examples
of the amazing work that primary careproviders do and how they keep their patients
healthier, everything from the preventive care, you know, preventing diabetes and high

(07:35):
blood pressure, early intervention, avoiding, for instance, someone going to the
emergency room where they sit for hourson end waiting for a problem that could
easily be addressed in the office bytelehealth or even in an urgent care setting.
And also in helping patients with confusionand understanding about what is the best

(07:58):
opportunity for them if they need arural to a specialist physician who is the
best match for not only their clinicalcondition, but a good match from a
personality perspective and someone who can reallyhelp to meet their needs. It's very
interesting. I mean, there's beendata out there now for fifty years or
longer that talks about that. Inthe medicare world, studies continue to demonstrate

(08:20):
that patients who have a primary carephysician consistently benefit from a higher quality of
care, a better experience for them, and also at a lower cost.
And you know, over it,excel us, we are doing this now
more than ever. We are workingactively with primary care doctors in our area
to make sure their patients. Thesefolks are our members and we're proud of

(08:41):
that are getting the care they need. We have partnerships with our providers to
assure that we are both together,working and being responsible for keeping our members
healthy. Hey, we all knowthat the costs are rising and a lot
of us is due to advances incare, and that's as fantastic, but

(09:01):
unfortunately, the data continues to showthat overall we're really not getting healthier in
the United States. And we're workingwith each provider to find the trends in
that data and the opportunities for themto tailor for tailoring agreements to work towards
improvements with our provider community throughout theyear. You know, docs are excited

(09:22):
about the opportunity and we want toempower them to deliver higher quality what we
call patient centric care, and theyreally have our support. That gives our
communities and everyone healthier citizens, peoplethat are more satisfied, and people are
really better able to manage care withtheir doctor rather than without. We share

(09:46):
a lot of data to our providerpartners. We want to make sure that
they are knowing what we know tohelp complete the picture of that full set
of information about people, so thatwhen they come into the doctor's office,
we have some stuff that we wouldlove to show, and we do so
that they have a full picture ofthe member's care. This is doctor Stephen
Cohen. He is our guest thisweek on the Community check In. He

(10:07):
is VP of Medical Affairs for Excellist, Blue Cross, Blue Shield, and
we're having a real interesting conversation onthis week's Community check In about health insurance,
not just what it is, butwhy it is and the far reaching
impacts that it can have. Doctorin the last answer you gave, there's
a lot to unpack there, andI want to come back to you just

(10:28):
for a little bit about the notionthat we're not healthier as a community,
or as a people, or asa nation. With access to care being
so front and center in many communities, including ours, there are many places
where care can be accessed. Theurgent care business model has really exploded in
a number of communities to put thiscare right there, close by, so

(10:50):
an emergency room trip isn't necessarily youronly option if you do not have a
primary care physician. Are we justnot taking step? Are we just not
being active and proactive for ourselves.Is that where we're falling behind here?
Yeah, I mean, I thinkwhat I wanted to mention is when I
talk about healthier, I look atit across a whole bunch of different areas.

(11:13):
There are there are national organizations thathave been following the care that is
delivered and what we'll call the outcomes, and the outcomes at the highest level,
the things at the highest level ofpublic health talk about things like average
life expectancy, a fetal mortality ratein children, obesity rate nationally, percentage,

(11:39):
and prevalence of diabetes, which hasreally become epidemic in our country.
And so what we see is incredibleadvances in care and incredible opportunities to make
people healthier. But I think weare at times not taking advantage of many
of those things. Vaccination rates,a whole bunch of stuff, which really

(12:01):
does question at times. You know, we spend the most per capita on
healthcare of any place in the world, but we don't have the results on
some of those measures I mentioned toreally show for that. And I think
that you're right. It's it's veryimportant to make sure that we think about

(12:22):
the real the entire spectrum of someone'scare from people that are healthy, trying
to keep them healthy. Individuals thatmay have individual or specific risks for future
illness, trying to address those earlyon so they do not spill over into
having an active condition. If theyget diabetes, they have high blood pressure

(12:43):
that we are we are treating andaddressing that on an individual basis for members,
thinking not only about the medication thatmight be appropriate based on the best
practices, but also about the lifestylechanges weight loss, exercise, assault restriction
is an example. So we reallywant to look holistically at individuals and not
just look at one particular pieces aswe might go forward. All right,

(13:07):
and we have talked on this programmany times before about the resources that excel
Us Blue Cross Blue Shield offers tothe community, both to members and to
non members. So let's bring itinto how the company then and how insurance
companies work sort of hand in handto help up that level of care to
make sure that community members are takingfull advantage of all of these resources because

(13:28):
sometimes they do need some help andmaybe a little guidance when it comes to
doing it. Yeah, you know, you you raise a great point because
you know, for excel Us,the information that we share on our website
about for instance, during the pandemic, the information that we shared about what
are the latest guidelines and recommendations aboutthings like social distancing, about things related

(13:52):
to vaccines, what's happening. Imean, we do that for our entire
community, and that's an important commitmentfor our entire community, you know,
for our members. We we wereach out in any of a number of
ways. We'd like to think itabout reaching out to our members and reaching
out to members of the community inthe way that they want to hear from
us. So that could be justgoing online, it could be a letter,

(14:16):
we get some we get some cutecomments. We send a birthday welcome,
a birthday card, a birthday letterto most of our members every year
and in it so for instance,if it goes to the children of one
of our members, we may say, hey, don't forget you know you're
due for your your pneumonia shot thisyear or your tetanus booster. And if

(14:37):
you're in your forties and fifties,happy birthday. By the way, you're
now ready to start having mammograms orthings like that. So we call people,
we send them text messages. Wedo it in any number of ways
that allow us to really connect bestwith folks to try to help them be
healthier, you know, on theprovider side, with our with our doctors

(14:58):
and our other provider partners, wemake sure that we are coordinating also the
things that we do as a healthplan for them. We directly try to
help our members. We reach outdirectly, and you know, we know
that any health topic is stressful,so we have a big team of care
managers, behavioral health specialists, andeven pharmacists to make sure that our members

(15:20):
are getting the right care in theright place and at the right time.
And because healthcare, as it isincreasingly complex, it is increasingly difficult to
figure out which way to turn,and we really do our best to navigate
and support our members by navigating withthem so that they can get themselves in
the best situation that they feel isappropriate, so they can have the best

(15:41):
possible opportunity. Think of this aslike kind of a small army of resources
that are in there in reserve,and they pop out when you need help.
So you know, I go ahead, I'm sorry, Yeah, I
was. I was going to say, you know, to wrap all this
stuff up. You know, forso many people insurance companies. Insurance is
only what we use to pay forcare, and that's it. We have

(16:03):
a very black and white sort ofview about what a provider is. It's
the co pay that we pay whenwe go to the doctor's office, or
how much a prescription is going tocost. But what you're talking about,
so I want to have to makesure we have enough time to expand on
it is that insurance offers so muchmore than that. And I want to
talk a little deeper about how ExcelsBlue Cross Blue Shield has been taking those
next steps to really bring it intothe communities, to reach the people and

(16:29):
talk to them where they are,how they need to be communicated with.
No, that's great, and I'vegot several examples that I can share,
and I'd like to begin by mentioningthat it is incredibly important. It is
critical for us to make sure thatwe are working with and in partnership and
support with everybody's individual doctor. Itis not our goal to get in the

(16:49):
middle between yourself, you know,you as a patient and your doctor.
But for instance, we regularly reachout to members on a proactive basis when
they are first diagnosed with diabetes,heart disease, depression or cancer. We
reach out to them and we talkabout the care plan that their doctor has

(17:10):
developed, what if any additional resourcesdo they need, and help in coordinating
needed care services and communication. Thesame thing happens from our pharmacy care team.
There are lots of opportunities to helpfolks make it easier for them to
take their medication, making sure they'regetting the medication at the best possible price,

(17:32):
also a place that's easy for themto get it. In other words,
someone who might be pretty much homebound, why do they have to try
to drag themselves out to the pharmacy. Let's use mail order as an example.
And we know because we've had somevery interesting things where we've worked with
individual members who have really pretty significantmedical disabling conditions and we work with them

(17:52):
to create situations where by changing whereyou might receive a particular medication, you
will not have to miss work asmuch, you can reduce your drive time
to get that treatment. And there'salso cost opportunities. There's cost opportunities for
the members and they're certainly cost opportunitiesoverall. When people have cancer, that
is an incredibly scary time. Wecheck in on members and if they say

(18:17):
I got it covered. I amworking with an amazing multidisciplinary care team over
at one of the local cancer centers. We get out of the way.
We do not want to be thatextra cook in the kitchen. But if
they need someone to talk to,if they're worried, they want to have
extra questions or conversations about the chemotherapy, the radiation or what's happening, We're
going to be there for them.We do, as I mentioned, lots

(18:38):
of outreach about overdue colon cancer screenings, mamographies and other things. And right
now we have a program where ifyou were to call a health plan and
all let's say you were called lookingfor a new membership card, we have
a program where we will actually thecare advocate, the customer care advocate has
another screen that will share what opportunitiesto close what we call those gaps in

(19:00):
care are available. So you callto get your membership card, you might
have a reminder to don't forget getyour flu shot, get your COVID shot.
We're thinking globally around that. Wehave all sorts of programs that reach
out to women who are pregnant,who newborns, pediatric adolescent kids. We
partner with local food banks to makesure and to help support people have more

(19:21):
food deliveries if they need them.And we also have this great team called
Community Connections, and these are ourfeet on the ground, our boots on
the ground, and they bridge thegap between the member, our care management
department providers, and our resources inthe community. And they actually go out
and meet with members in their homes. They do wellness checks to make sure

(19:42):
they're not falling through the cracks,and do all sorts of things in this
arena. It's amazing what we've beentalking about during our time here. And
this is doctor Stephen Cohen to guestwith us on Community check in this week.
He's VP of Medical Affairs for ExcelisBlue Cross Blue Shield. You know,
we've tried to flipped the narrative aboutwhat insurance is and what a health
insurance provider can be. Typically,they get I think the entire industry kind

(20:07):
of gets a bad rap. It'slike you're just the money people and you're
just trying to save a buck ormake a buck. But as I hear
excel US's approach to this, itis about as we mentioned at the beginning
of the program. If you're ableto get and reach people in the community
where they are, provide them withat least the knowledge to help them get
the services, the screenings, theprevention, find care that they need,

(20:30):
it winds up being so much betterfor everyone. It really is truly a
win win situation, and there aren'tvery many of those when it comes to
health. No, No, you'reright, and you know, sometimes it
is a challenge for folks to cutthrough some of the rhetoric, and I
think we acknowledge that, and Ithink that that's really an important thing to

(20:51):
mention, you know, Joe arewe are unique as Excels Cross Bushield.
We are a mission based nonprofit organizationand we really do strive to help people
in our communities and this is ourvision. We want to serve member the
people in our communities to live healthierand more secure lives through access to equitable,

(21:11):
high quality, and affordable healthcare.And that that really does give us
the opportunity to rethink the role ofan insurer, to broaden the definition of
health and make more make care moreaccessible and affordable. No one should have
to worry if they'll be able toafford medical care or where to turn when
life changes things for them, andwe're doing this now. We offer lower

(21:36):
no cost coverage for individuals. Wehave medicare plans that have hearing and vision
and dental coverage, and we evenhelp businesses tackle tough topics like mental health.
Plus we are really focusing in nowon health equity. We have a
full team of individuals that are workinghard to collect necessary data out in the

(21:57):
community, things like ray, ethnicityand language data, sexual orientation, gender
identity, among other things, becausewe want to work hard to remove barriers
to care and address those long standinghealth and equities. And I like to
think that we can support entire populationsand focusing on emotional health and we make

(22:18):
progress in by that way to livehealthier lives. And this is what all
four thousand of us that work forExcelis Blue Cross, FLW Shield up and
down the through Way are doing eachand every day. And at the end
of the day, what it reallycomes down to is that that holistic approach
for those of us who are justgoing about our daily lives will notice.
We will notice when our communities arebetter, are healthier. Because I don't

(22:44):
think you can't notice, No,you can't and I think that if you
take a step back and look atwhat health carriage, health coverage can bring
beyond just paying that claim, itreally means more than just the health plan
you have and your premium, becausewhen everybody has health coverage from a global
perspective, everybody in the community benefits. And that is how Excelist, Blue

(23:07):
Cross Blue Shield has been reaching intoall communities and trying to raise all ships.
It's for members, it's for nonmembers, it is for the entire
community to take advantage of the informationthat is out there. Oftentimes, especially
with what you mentioned about the websiteand how much is available on there,
I mean sometimes there's an awful lotof noise. If you just go to

(23:29):
one source, one trusted source,you can find so much that is available
to you to start having a conversation, to start saying, you know what,
I don't know all the answers.I need some help and reach out
to be able to get that help. Absolutely, people are welcome to go
to choose excelist dot com and you'llfind health insurance options there. Whether you're

(23:51):
looking for yourself, your family,or for a business. We're happy to
speak with you at eight eight eightfour three five three nine for zero.
You can follow us and find uson Facebook, Instagram. We offer sharing,
offer offense sharing, wellness tips,program information, and don't forget.
If you're remember, please reach outto us if you have any needs.

(24:11):
We have an app. I useit all the time and it's call the
number on the back of your cards. Sign up on our website, so
get engaged. We're there for you, were there for everyone. Thank you.
Doctor Stephen Cohen is VP of MedicalAffairs for excel Us Blue Cross Blue
Shield. Thanks for flipping the scripton health insurance in our conversation on Community
check In this week. Doctor,Thank you for inviting me. It's a

(24:33):
real pleasure. Thanks for joining uson Community check In a presentation of excel
Us Blue Cross Blue Shield at iHeartRadio. Podcasts of Community check In are available
on the iHeartRadio app or wherever youfind your favorite audio content. For more
ways to stay safe, healthy,and educated, visit excel Us BCBS dot

(24:55):
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