Andrew Dreyfus, the chief executive of Blue Cross Blue Shield of Massachusetts, is stepping down after 12 years on the job. He says he is leaving the state’s biggest health insurer to teach, mentor, write and advise young companies.
Sarah Iselin — a Dreyfus protégé — will become CEO of Blue Cross on Jan. 1.
Dreyfus, who is 64, pushed to change the way health insurers pay for care, with rewards for doctors and hospitals that provide high-quality care, not just those that provide the most tests and procedures. And he worked with coalitions to pass landmark health care reform laws in Massachusetts and nationally.
WBUR spoke with Dreyfus about how health care is changing, and the challenges that lie ahead.
Below are highlights from their conversation, which have been lightly edited.
A big part of your work at Blue Cross was pushing new payment models that focus on quality and equity. Have these efforts been successful? Do you wish more had been done?
"Our payment approach advanced two key goals in health care: It improved quality, and it made care less expensive. A lot of our payment model was focused on primary care, and I think we've made a lot of progress there, but a little less on specialty care.
"Right now, we probably pay less than we should to primary care and cognitive specialties like psychiatry. And we pay more than we should for specialty services, especially surgery. In some ways, I'm proud of what we accomplished, but I'm disappointed we didn't even go further.
"I'm so excited that we're now incorporating health equity measures into our payment arrangements with physicians and hospitals."
Massachusetts passed a law in 2006 to expand health insurance to all residents, followed by a 2012 measure to contain medical costs. At the national level, there was the Affordable Care Act. Have the state and the country made progress on health care access and affordability? Most people in the state have insurance, and yet many are still delaying care because the costs are too high — is that progress?
"In Massachusetts, 98% of the population has health insurance. That's a major advance. And a series of studies have shown that when you have insurance, you get better care, and you get better results. So we know that health insurance is important, but it's not enough.
"We know that people still face barriers to care. Our health care system is imperfect and fails too often. But I feel really good about the progress we've made in Massachusetts.
"The other thing I'd say is unique about the health care system in Massachusetts is how closely we collaborate. While there are times we disagree, whether it's health plans or employers or hospitals or labor or elected officials, when the time comes and there's a big problem — like half a million people without health insurance, like the COVID pandemic, like the mental health crisis, like the opioid crisis — we tend to rally together. We work together to solve the problem."
What do you see as the long-term effects of the pandemic? What will stick around in terms of how we get health care?
"The move into virtual care is going to stay with us in mental health care. Before COVID, [Blue Cross] would pay for just a few thousand virtual mental health visits. Now, we've paid for almost 8 million virtual mental health visits this year. It's just a revolution.
"Our understanding of how we combat respiratory illnesses has changed. Our use of masking, which had been commonly adopted in Asian countries for years, will become more a feature of our health care system.
"Long COVID is a big unknown, and the early reports suggest that a pretty high percentage of COVID patients will develop some long COVID symptoms. We're going to have to work hard to set up the right kind of clinical response to that.
"The breakthrough in [COVID] vaccine and drug development and how quickly it happened was a great lesson. That shows what American and global innovation and ingenuity in the life sciences can create. That is a kind of silver lining."
Do you have any regrets as you look back on your career?
"I feel so proud of what this company and this community has accomplished together in health care: expanding coverage, responding to the opioid crisis, improving care for mental health, taking on health equity, and trying to improve health care affordability.
"One always looks back and says, 'Could we have moved faster in some of these areas?' I often wonder about that.
"We just came through one of the most divisive election periods in our country. But there was one issue that almost wasn't discussed at all, and it was the Affordable Care Act. Back in previous elections, that was one of the top issues. It's become part of our social compact.
"I think the lesson is that change takes time, and big change takes a long time."