Home > PUM One on One with Dr. William Winkenwerder- Highmark President & CEO

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PittsburghUrbanMedia.com One on One Dr. William Winkenwerder, Highmark President and CEO – One of the most influential leaders in American health care


PUM: Dr. Winkenwerder as one of the most influential and recognized leaders in American health care, and as a prominent expert on the issues of national health policy and the economics of health care-some would argue there is a lot of waste and a lot of opportunity to improve our current health care system-what are your thoughts on this issue?



Dr. William Winkenwerder:

As a nation, our number one priority needs to be finding solutions to slow the growth of our health care spending. Health care costs are unsustainable and increasingly place a drag on our global competitiveness.


To some extent those costs are driven by preventable waste such as duplicate medical testing, unnecessary procedures, fraud and provider billing practices.


While we must address these issues, a more basic issue is that providers are paid for volume and not value.


When doctors see you, they are paid for that visit no matter how well you’re treated and regardless of the outcome. It doesn’t matter if you get better or worse. Paying health systems in this way provides no focus on care outcomes and can actually encourage health care spending.  It is a problem that requires a lot of education and awareness. 


A second – and in some ways even more problematic – issue is that consumers are not engaged in the purchase of care.  They are usually shielded from the actual cost of health care procedures through our health insurance coverage and also by confusing bills and billing statements that make it hard to understand where the dollars are going.


If you ask Americans how much a gallon of gas costs, they can tell you within pennies. But if you ask them how much an x-ray costs, they probably couldn’t tell you within hundreds of dollars.  That must change.  And it is beginning to change.  Highmark wants to be a leader in helping individuals get real value from their health care dollars.



PUM: Many Americans feel that they should expect to get and should demand to get better value for their health care dollar, how is HIGHMARK helping to keep costs down while also providing quality health care?


Dr. William Winkenwerder:

Highmark is working with hospitals and doctors every day to transform the payment model towards the value of the health care provided and not the volume. The industry calls these models “patient-centered” and focuses on “accountable care.” The goal is to improve the patient experience and deliver high-quality care at a lower cost, consistent with our vision to ensure that all members of the community have access to affordable, quality health care.


Consumers also have a growing role in health care costs. Through products like high-deductible health plans and our Community Blue, select-network product in Western Pa., we provide incentives to consumers designed to reward them for understanding health care costs and choosing the provider that’s right for their needs.


We further educate consumers by providing suites of robust transparency tools online, where members can view detailed information about physicians including outcomes, patient reviews, and costs for basic services relative to other providers.


PUM: Often we see various reports on how to reduce ethnic disparities in health care, and still experts say little has been done to systematically address the issue and startling health inequalities persist in the USA-please share your thoughts on what you feel should be done to help bridge the gap in health care for minorities. 


Dr. William Winkenwerder:

Reducing health care disparities is a priority for Highmark. Our dedicated Health Equity & Quality Services department leads our efforts to reduce disparities and improve the delivery of culturally and linguistically appropriate services.


Our attention to this issue has been nationally recognized, and we remain the only insurance plan operating in Western Pennsylvania that has received recognition by the National Committee for Quality Assurance of Distinction in Multicultural Health Care.


Highmark provides cultural competency training to network physicians, nurses and office staff through partnerships with medical societies, network hospitals and practices.

We voluntarily collect race, ethnicity and language information from members willing to share it, and we use this information to help close gaps in the quality of care that our members receive.


No one entity can by itself eliminate the gap in health status for minorities, but Highmark is a proud leader in this space.



PUM: It has been about a year since you took over as CEO of HIGHMARK, since that time, what would you say are some of your major accomplishments and challenges?


Dr. William Winkenwerder:

They say it takes a lifetime to become a Pittsburgher, but I do think that the community has embraced me and continues to support our work to transform the local health care market and preserve choice in the region.


The major challenge, and accomplishment, of my first year here at Highmark has been the creation of the Allegheny Health Network and the restructuring of our company, which was completed in May. Allegheny Health Network is the culmination of successful affiliations with Jefferson Regional Medical Center, West Penn Allegheny Health System, St. Vincent Health System and many physician practices across the region.


Allegheny Health Network will help to usher in new ideas in transforming health care and focusing on the patient experience.  And Highmark, our parent company, now oversees all of our businesses, including Highmark Health Plans, Highmark Diversified Businesses and Allegheny Health Network.


PUM: The contract between Highmark and UPMC -- which allows most Highmark customers to use all UPMC facilities -- expires at the end of 2014. Highmark customers would lose "in-network" access to UPMC if no contract extension is reached. You have publicly said Highmark desires a "long-term, stable relationship" with UPMC-what are your thoughts regarding that partnership? 


Dr. William Winkenwerder:

Not-for-profit hospitals are built and paid for by the community – through health care premium dollars, tax dollars and charitable contributions.  Highmark enrollees, employers who use Highmark, and other citizens of this community helped to build UPMC.


Community assets should be open to all. That’s why it’s important that we continue to work with UPMC. It is in the community’s interest for the region’s largest hospital system to be accessible to the millions of enrollees of the region’s largest health insurer.  We are two large systems with big responsibilities.  We need to work together.


PUM: When it comes to the issue of being committed to Diversity, it is noted that at Highmark, diversity and inclusion are essential to your business and culture. What are your personal thoughts about what diversity and inclusion means to you personally? 


Dr. William Winkenwerder:

Highmark aspires to be a leader and to innovate in the health care space. Our vision is to ensure that all members of the community have access to affordable, quality health care. To do that, we must welcome and cultivate different perspectives, and we must reflect the communities we serve. You can’t do that without diversity across your organization.


Communicating effectively to consumers is increasingly critical. The need to educate and inform has never been more pressing. Major health and sustainability benefits will come to those groups that can inspire large groups to better wellness and promote health equity across lines of gender, language, and ethnicity.


Again, you can’t do that without diversity.


You ask about my personal thoughts. Among my many experiences in public and private sectors, I would highlight my time as the Assistant Secretary of Defense for Health Affairs at the Department of Defense. In that role, I was responsible for supporting a large network of health care services for our U.S. Military active duty, veterans and their families.


This health care network was extensive—covering the globe, including military facilities and partnerships with private providers and insurers. The work that we accomplished encompassed a broad spectrum of talented individuals and groups from various backgrounds and experiences.


That rich diversity of people and organizations allowed us to deliver unparalleled service to military members and their families across full spectrums of care.


What was true there is equally true at Highmark. Our ability to grow as an organization and meet the needs of all our members and communities depends on having a diverse, engaged and inclusive workforce.





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