Nov. 29--Karen Cox didn't intend to get into the insurance business.
But 35 years after starting her career with Blue Cross Blue Shield, she feels like she's in a position to effect change through ProviDRs Care.
For three years, Cox has been the chief operating officer for ProviDRs Care, a physician-owned preferred provider organization.
ProviDRs Care started in 1985 and is a for-profit entity that is under the umbrella of the Medical Society of Sedgwick County.
It currently has more than 5,600 physicians and midlevel practitioners within its network in Kansas and border cities in Missouri, Oklahoma and Nebraska. The company has experienced 30 percent growth in the number of covered lives over last year, Cox said.
"It's a different type of player in the health care delivery system," Cox said. "To really go from an insurance company to an insurance broker and consultant to a PPO network owned by physicians has been a fascinating career path for me."
After graduating from Wichita State University with a degree in business and marketing, Cox worked for Blue Cross Blue Shield for more than 20 years and for IMA of Kansas as an insurance broker and consultant.
When she's not working, Cox enjoys living in the country, raising horses and staying active. She is also chairwoman of the board for a local chapter of the American Heart Association.
Q. What are some of your goals for ProviDRs Care?
A. Our goals are always going to be to continue to enhance the role of the physicians and to improve the quality of care and to factor that into the needs of our community because the success is from collaboration and we all need to work together -- patients, employees, employers and providers -- in this community to make a change in how health care is delivered.
Q. Do you foresee more PPOs in the future?
A. As far as a PPO network, I see them declining in number.
First of all, there were a lot of mergers that took place at the national level. The larger insurance companies have their own PPO network. The role that we play as an independent PPO network for lease is that we allow there to be choices and competition. ... We play a big role in the health care delivery system. It would be sad if networks like ourselves were eliminated, because then you have fewer choices. Fewer choices means you have less competition, which leads to, I believe, higher prices.
Q. What is one of the biggest challenges for ProviDRs Care?
A. It's challenging in this industry when you're a small company and you're competing with the large companies like Blue Cross Blue Shield and United and Coventry.
However, the fact that we are physician-owned and we're just focused on the state of Kansas, I think gives us a unique niche in that we work harder in meeting the needs of Kansans.
It's been rewarding in that, because we are a small organization, we can make changes quicker and have a lot more flexibility, and that has enabled us to do some things that are fairly unique.
Q. What are some of those projects?
A. We decided to diversify outside of our commercial business and we've partnered with Centene Corporation, which formed Sunflower State Health Plan in response to the KanCare (the state's privatized Medicaid program) bid, and with Sunflower State being one of the three chosen bidders, we're assisting them in building the network for the Medicaid population. That's been really exciting working with them.
We've also partnered with Central Plains Health Care Partnership in the formation of a health care cooperative in Kansas, which is basically another insurance company, so we're just waiting on word from the federal government to see if it will help fund that program. That will provide Kansans another option for their insurance.
Q. Has insurance changed in the last several years, and what's next?
A. It has changed a lot because of Obamacare (the Affordable Care Act). I'd like to say that we all have a better understanding now that the election's over, but I'm not sure that's true. There's so much uncertainty now with what's going to happen with the exchanges.
That's probably the biggest question we have, the fact that so many states, including Kansas, are not going to set up their own exchange and are going to rely on the (federal) government to do that, and I don't think that a lot of us have faith that that's going to happen, that the government is going to set up that many exchanges that quickly and work well.
My philosophy is to not sit back and wait for the government to fix it. We have to anticipate what the regulations are going to be and operate within, but I believe we all still need to proceed with innovation and try to find a way that will truly improve outcomes and reduce cost.
Reach Kelsey Ryan at 316-269-6752 or [email protected].
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