12.09.2019

Health insurance giants are getting into the primary care business. Here's why Anthem's CEO isn't interested and what she's doing instead.

Dec 9, 2019
The Business Insider / ACI
By: Lydia Ramsey

Health insurance giants are getting into the primary care business. Here's why Anthem's CEO isn't interested and what she's doing instead.

Health insurers are increasingly getting into the business of owning primary care practices as a way to better control healthcare costs. But Anthem, the second-largest health insurer in the US, doesn't want to get involved in that business, according to CEO Gail Boudreaux.

"We've been pretty clear that we don't think we need to own primary care," Boudreaux said onstage at the 2019 Forbes Healthcare Summit in December. Instead, she's working to partner with doctors with the intent of better managing members' health at an earlier — cheaper — stage.

Boudreaux is the CEO of Anthem, the $72 billion health insurer that offers health plans under the Blue Cross and Blue Shield brand in 14 states. Anthem provides health insurance to about 41 million people, making it No. 2 in the US. Boudreaux's comments come at a time when health insurers like UnitedHealth and CVS Health's Aetna are increasingly getting into the business of caring for patients. It's part of a push by healthcare companies to gain more control over how healthcare gets paid for and provided to patients. For instance, UnitedHealth — where Boudreax once oversaw the health plan business— is playing a bigger role in the business of providing medical care. The company's OptumCare business employs or works with 46,000 doctors, from surgeons to primary-care providers. UnitedHealth wants OptumCare to reach $100 billion a year in revenue by 2028, up from roughly $16 billion last year. In 2018, CVS Health closed its $70 billion deal with the health insurer Aetna, which combined a retail pharmacy and an insurer with the hope of being more involved in Americans' healthcare. Humana owns Partners in Primary Care, a senior-focused primary care practice.

Altogether, the health insurer owns either wholly or through joint ventures more than 230 primary care practices. Anthem for its part has been shoring up its own business, creating its own pharmacy benefit manager, IngenioRx and then managing care directly for more sick patients through organizations like Aspire and CareMore.

Instead of owning primary-care practices, Boudreaux said she'd rather partner with doctors to help manage the care of Anthem's members.

"Quite frankly, I don't believe that by changing ownership we'll be more effective at managing primary care," Boudreaux said.

What Anthem's doing instead rather than own doctors, Anthem's been partnering up with health systems with the hope of keeping Anthem members healthier and helping them be more proactive about their care. Boudreaux cited the company's work with the Cleveland Clinic. The two organizations offer a Medicare Advantage plan to seniors in Ohio. The two also have an agreement around heart benefits for certain Kroger employees. She also cited Anthem's work with South Bend Clinic, an organization with 150 providers covering everything from primary care to surgery. Under the agreement, the two organizations share in the risk and reward of keeping patients healthier.

"We want to keep practices independent. That's our goal," Boudreaux said. As the definition of the health insurance business keeps changing — with rivals and Anthem itself adding additional pieces under its purview — it'll be key to keep in mind what role an insurer can play as the one covering healthcare costs, she said. "I don't think we have to do it all," Boudreaux said. "We need to be good partners for the rest of the space, but we also are the voice of cost. That's where we get held accountable."