Doctors Working at an Insurance Company? Yes, and Here’s Why
I’m lucky to have a career in medicine that gives me the chance to see the health care system from a lot of different angles, including the patient and family perspectives.
As a pediatrician who is still practicing, I hear directly from parents who are struggling to get the best care for their families – without going broke in the process.
And now as the CEO of Blue Cross and Blue Shield of North Carolina (Blue Cross NC), I see how policies at the national level can help or hinder the private insurance industry’s efforts to bring better value to health care.
I may be the only practicing MD currently leading a major health plan in the United States, but I am not the only MD at Blue Cross NC, of course. We employ a number of doctors – our medical directors – who bring a clinical perspective to how health care can be delivered effectively and affordable, and many of them still practice medicine. Our medical directors have taken the same Hippocratic Oath as any other doctor, pledging to use science, ability, and judgment to bring healing to those who need it.
But much of our medical directors’ work is behind the scenes, and many of our customers are unaware of the team of advocates working on their behalf. Our medical directors work to ensure that our members get the right level of care at the right time, based on the most recent evidence-based treatments available.
I asked some of our medical directors to describe the ways they’re working for our members.
Supporting Other Doctors
Sheila Stallings, MD
Associate Medical Director at Blue Cross NC since 2016
As a full-time practicing physician, Dr. Stallings had questions about the role of insurers in health care, but she learned that insurance companies are a resource rather than an obstacle:
“I quickly understood that insurers aren’t an obstacle, they offer valuable resources for doctors. In my role at Blue Cross NC, I get to fill that role in consultations with the doctors in our network. I feel like my work supporting other doctors amplifies my contribution to the state’s health.”
Connecting with Communities
Janet McCauley, MD
Senior Medical Director at Blue Cross NC since 2008
Dr. McCauley enjoys the personal connections that our medical directors maintain with the people of our state:
“Many of the medical directors here at Blue Cross NC are still involved in clinical practice, still seeing patients – many of them our customers – regularly. That personal connection to North Carolinians is one of the big differences between our company and the big national plans. We have a presence in communities across the state.”
Improving the Patient Experience
Anuradha Rao-Patel, MD
Medical Director at Blue Cross NC since 2015
Dr. Rao-Patel sees unique opportunities for medical directors to affect the health of entire communities:
“Serving on medical boards and advisory councils allows us to transform health care at a population level, impacting a large number of patients. Our goal is to make sure North Carolinians are getting value out of what they’re paying for health care – that means the most effective tests, treatments, and medicines at a cost that’s affordable.”
Simplifying Health Care
Hugh Donohue, MD, MHA
Medical Director at Blue Cross NC since 2009
Dr. Donohue embraces the chance to pass on knowledge and information while he continues to learn:
“Most medical schools excel at teaching doctors about patient care. But today, doctors have to know as much about finance as about medicine. We try to help doctors master some of the complexities of health care outside of the doctor-patient relationship. Being a doctor means maintaining a commitment to learning throughout a medical career.”
Answering the Call to Serve
Larry Wu, MD
Medical Director at Blue Cross NC since 2004
Dr. Wu values the opportunity to continue on a lifelong path of learning:
“Insurance companies are uniquely capable in health care, able to see health care utilization on a large scale. As medical directors, we have access to data that provides us with insights into our state’s collective health, sharing that data with doctors and health systems who are providing front-line care. The role of medical director is perfect for doctors who are obsessed with learning. We have an infinite curiosity about the science of health, and we get to satisfy that curiosity in service to others. Isn’t that what every medical professional dreams of?”
Using Science for Advocacy
Esther Seo, MD
Medical Director at Blue Cross NC since 2014
Dr. Seo is proud of Blue Cross NC’s medical directors’ commitment to fairness:
“Much of our advocacy for our members is sort of invisible, but we’re always working behind the scenes to help identify members’ needs early so their care is timely and effective. One of our priorities is making sure health care doesn’t become a ‘bottom line’ industry where the quality of care and the patient experience are compromised for the sake of profits. That focus on people is a guiding principle for us.”
Blue Cross NC’s medical directors are an outstanding resource for our customers, bringing value to health care through their expertise and perspectives. I’m proud to work with them toward a health care system that delivers quality care that’s affordable while providing an exceptional experience.
