Strategies for Educating Consumers

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Sanjula Jain, Ph.D.: It’s my pleasure to welcome Dr. Andrea Willis, Chief Medical Officer of Blue Cross Blue Shield of Tennessee. Dr. Willis, thank you so much for being with us today.

Andrea Willis, M.D.: Thank you for having me.

Sanjula Jain, Ph.D.: You have a very unique role where you get to see a lot of things firsthand. As we've been talking about all day, the health economy is really at a cusp of a lot of transformation. Tell us a little bit about the major trends that you're thinking about over the next three to five years.

Andrea Willis, M.D.: We’re thinking about the lessons that we've learned. I come from a public health background. I served as Deputy Commissioner for the state. I still have a lot of that public health mindset. Some of the things that we saw, even with the pandemic, was really that it does take a public health approach. That doesn't mean just health departments. That means everybody; it means the healthcare system; it means everybody that supports healthcare; everybody needs to be at the table. I think that's what we’ve learned. I think that's what we're going to really use as momentum going forward.

I think we're going to start to see more of, “What do we do for the greater good?” It's not just about clinic services; it's also about the social drivers of health. That’s one thing. Then, as we talked about today, how do things like telehealth and telemedicine play into the future? I do feel like we're going into a more consumerism state of healthcare. But I do think that we have to have everybody at the table to make sure we're driving it in the right direction, because, if we don't, I'm afraid we're going to fragment care.

Sanjula Jain, Ph.D.: I would argue that, in some ways, we're probably already starting to see signs of that fragmentation. I know there's been a lot of discussion about this consumerism, and commoditization of care, which maybe has some positives in terms of consumer desires and preferences.

But from a clinical perspective, I'm interested in how you view the responsibility of really all healthcare stakeholders, payers, providers, and public health groups, in terms of educating the consumer from a healthcare perspective. I get that you have to manage the experience to meet consumer preferences, but it's also healthcare. So, how do you educate?

Andrea Willis, M.D.: It’s really being consultative if you will. A lot of times, if people don't understand their stake in it, then they don't move to shift it in the right way that's best for them. A lot of times, they're driven by what they see; it's a lot of direct-to-consumer advertising these days. People think, “I need that. It was advertised; it must be good.”

We're at the point of saying, look, these are your options, and these are your responsibilities with these options. People think all the time, “Oh, you want to control costs,” and you're trying to paint the big picture: if healthcare costs keep going up, premiums go up. So let us help you understand that this is the responsibility of what you're asking.

I think we have a role to be more consultative and just more honest. Medicine shouldn't be just about the advertisement you hear on TV; it really should be about the relationship you have with people that really want the best for you.  Sometimes, what's most expensive is not the best for you. But really, having that conversation; it's about relationships. I really found out that we have to be a little more forthcoming in that relationship. We don't want people to not want our services. A lot of times, you try to go, okay, let me see how I can serve. But the best way to serve is to be honest and truly caring.

Sanjula Jain, Ph.D.: Thinking a little bit about your public health roots, we've talked a lot about politics this week. We're in a midterm election season, right? They target their consumer to educate them on political issues. We have pharma companies who do that on the medication side; we have some of these more retail consumer brands who are doing that from more of a general marketing perspective.

But is it anybody's responsibility to educate consumers on the risks of not managing their diabetes? Maybe the pandemic forced you to limit the amount of time you saw your physician; maybe you should remember to go get your cancer screening; or maybe you should go get annual bloodwork, just like how we do flu shot campaigns. Pharmacies all remind us that it’s time to get your flu shot. But no one's really reminding us; hey, have you seen your primary care doctor today? When was the last time you saw them? Or have you thought about getting a checkup? Do you think there is a need for that as we think about the current health economy and the future public health burden?

Andrea Willis, M.D.: Absolutely. We have health navigators, for example. Their job is to outreach and do that very thing, but I think the biggest thing that really happened authentically with the pandemic was that we saw so many health inequities and health disparities that were exacerbated during that. We also saw things going on in our environment; we saw more visualization of the racial injustices and things that were going on. We pride ourselves in having a diverse staff because we serve diverse people. But there became a rawness to it as well, where people weren't okay during that time period. The stressors became so great.

I didn't mind saying to myself, I'm not okay. I'm not okay. So, let's get real. Our members are not okay. If I'm not okay, and life seemingly is good for me, for those that may be struggling with things even more than I am with this on top of it, people are not okay, so let's get real. Let's have real conversations. Let's not do it with polish; look, we're hurting. We have behavioral health services; you need to access it. Hey, you're not going to get your checkups. Do you know you could be delaying a cancer diagnosis? It's not ever a good time to have one, but one that's delayed when something could have been done; we don't want that to be your story. So, I love that authentically, we shift it to a place of not going to sugarcoat it.

Sanjula Jain, Ph.D.: Are you getting good responses from members as you're engaging with them in those messages?

Andrea Willis, M.D.: Yeah, people are shocked, I think, a lot of times to really hear; I think if you lead with that vulnerability: “I'm not good, so no judgments if you're not”; that type of thing. I think people first were like, I'm serious; you're really going to say this out loud. I'm really going to say it out loud because if I'm not serving in that regard, I don't know what all this work is for.

I'm thankful that the company embraces that as well. We really did have tough conversations and got to that level of vulnerability. Every once in a while, we remind people. We're putting out a health equity report soon because we don't want to let that go. I think a lot of times, that is a very true and visceral response. But then, when you feel a little bit better, you're not as loud anymore. We don't want to stop being loud.

Sanjula Jain, Ph.D.: That's great. Well, I look forward to reading that report. Now I have so many more questions than we have time for, so maybe I’ll end with one big one. I know we've talked a lot about virtual care and telehealth. What do you see as both the greatest opportunity but also challenge that we have as we think about the future of the telehealth economy, say, over the next three years?

Andrea Willis, M.D.: I think the greatest opportunity is that we can reach more people, and we can reach people that maybe had barriers to having access to care otherwise. So that's exciting to me.

The challenge, though, is I think everybody saw how quickly things could change and pivot because telehealth was a prime example of that during the pandemic; everybody came together. We moved in a few months, which would have taken us ten years to do previously. I think a lot of innovators saw that and said, oh, here's a bandwagon for us to jump on. I think we need to innovate together, as opposed to everybody innovating in their own little space, so that we have a greater outcome versus a fragmented outcome.

Sanjula Jain, Ph.D.: Well said.