Sarah Iselin looks ahead to new role leading Mass. BCBS

By Doug Bailey

Early next year, Sarah Iselin, 51, will become the first female CEO of Blue Cross Blue Shield of Massachusetts, the state’s largest insurer with nearly 3 million members and $8 billion in revenue.

It’s an interesting time in the state, which will likely also see its first female governor sworn into office at about the same time, and women head up three of the top hospitals in the state.

But beyond demographics, it is a critical time in health care in Massachusetts and elsewhere as institutions emerge from years of COVID-19, facilities are calling for higher reimbursements, and insurance and health care overall and becoming unaffordable for many.

Iselin, who served as the commissioner of the Massachusetts Division of Health Care Finance and Policy, was instrumental in creating Massachusetts' 2006 health care reform law, then dubbed RomneyCare, which became the model for the national Affordable Care Act, known as ObamaCare.

"Consumers have easier and easier experiences these days...Healthcare has an opportunity to continue to close that gap in the quality of experience they're getting in those other sectors."
— Sarah Iselin, incoming CEO, Blue Cross Blue Shield of Massachusetts

She returns to the state from a stint as the chief operating officer of Blue Shield of California, a much larger insurer than BCBSMA, but not nearly as vital to the state’s overall economy.

From her apartment overlooking SanFrancisco Bay, Iselin took time for a chat with InsuranceNewsNet.

Q. You've taken an interesting route to this job. I think I read somewhere you were an art major. So how did you end up in healthcare?

A. My story is a great example of just do something, put yourself out there, work hard, explore experiences, and you will find something that needs you and clicks. I moved to Boston after college. I wish I could say picking healthcare was this big strategic thing. It wasn't. I landed a job through a family friend, an entry-level job at the Visiting Nurse Association of Boston. And while I was there, it quickly resonated with me as something that touches all of us. You come into the world accessing the healthcare system and have lots of points of intersection with it. And it's how most all of us go out in the world. It’s expensive and complicated. And, in spite of the really great intentions of all of us who work in healthcare, it often lets us down at times when we need it the most. And I believed that it was an area where I could make a contribution.

Q. Is that still the biggest challenge facing you: affordability, access, and things like that?

A. I was much more focused on healthcare access and was so lucky to be a part of this extraordinary community in Massachusetts, a state that made more progress than any other state tackling what had been perceived as this intractable problem of the uninsured. That inspired the country with the blueprint for the Affordable Care Act, which obviously dealt with a lot more than just coverage. But it became very clear for those of us working in Massachusetts, that you can't sustain the progress that we made on covering the uninsured unless you next tackle the cost of health care. And so my career really quickly pivoted to that issue. And that’s a harder issue to tackle than coverage. But making healthcare affordable is infinitely more complicated and has been a massive area of focus of mine and will be for the company, as it has already been. But I'd say there are a few other issues on the list -- like equity, a huge area of passion of mine. And already it's been a part of what made this role so appealing. It's an area that Blue Cross of Massachusetts is already leading on. I'd add behavioral health to the list, and mental health access, particularly for kids. And while we're making progress, there's still a long way to go.

Q. Those are big ticket items. Anything else?

A. For me personally, this is an opportunity to inject even more empathy and recognition of the need for more humanity in health care. We've still got opportunities to show up in a more supportive way in the most vulnerable moments of people's lives.

Q. Do you see huge changes in insurance since passage of the Affordable Care Act? Is it still evolving?

A. Like every law, it is continuously tweaked. You look at the Medicare program, you look at any government sponsored health insurance program, and the regulators and officials and legislators who manage it are continually looking at ways to improve it. So that story continues to unfold though the commitment to it remains strong. As we've seen, it's been challenged multiple times. It's still the the law of the land. And we're really seeing an even greater level of focus on affordability in the national policy conversation.

Q. Are the recent efforts by the Biden administration to allow Medicare to negotiate drug prices a big deal for all insurers?

A. Laws that get signed take a while before you see the impact. They’ve got to issue regulations. But I do think it is from a policy perspective. It's a really significant and important move. Because as we think about how we make healthcare more affordable, we have to think about all the different areas of spending. That includes pharmaceuticals, in addition to everything we're all doing as a community to work on the other aspects of costs, outpatient care, and inpatient care. This is an important part of that equation that goes into the total cost of health care.

Q. What's the future role of the advisor broker in healthcare insurance? is it is going to go all digital? Do we need them anymore?

A. They are critical partners to us as a health plan. They're critical partners to employers. I do think we'll continue to see innovation in terms of digital tools and access. But from our perspective, they remain critical partners.

Q. We hear a lot about how customers want their experience with insurers to be like their experience with Amazon. They want quick decisions and settlements, they want their policies today, etc.

A. Consumers have easier and easier experiences these days, whether it is with their retail stores or financial services. Healthcare has an opportunity to continue to close that gap in the quality of experience they're getting in those other sectors. There are always opportunities for us to improve as a health plan. But I think that also extends to just the experiences that consumers are having: trying to find a doctor and make an appointment, and have that appointment be on time when they show. So we, as a payer, will continue to partner with all of those players in the broad healthcare ecosystem, to really do better to provide digitally that simple, affordable, experience that consumers are right to expect, given how much they pay for health care.

Q. Anything else top of mind as you prepare to make the move?

A. Underneath affordability is the changing way we pay for care. The government is getting more involved now in the price of drugs, but we have not been waiting. Going back a decade, Blue Cross Blue Shield of Massachusetts was one of the earliest plans to really lead and get an innovative payment model in there that we call the AQC, the Alternative Quality Contract. And we've continued to evolve it. One of the more recent innovations was to introduce health equity measures into that way of paying providers. And so that connects the dots around health equity. We've set incredibly ambitious goals out there to eliminate health inequities. We're incorporating that into the way we pay providers for care. And we've just released and created total transparency in terms of the experiences that our members are having right now, which is just yet another way in which we're leading. And, really, we're just putting our current performance out there and holding ourselves accountable for doing better on behalf of our members and on behalf of the employers that we serve.

Q. How big a deal is it to be the first female CEO of Blue Cross Blue Shield, which is about 85 years old?

A. It’s really an exciting time to be a woman in leadership. I'm really excited to see the progress that we're making, not just in Massachusetts, but nationally, creating more opportunities for women and people of color to lead. And we have a lot more progress to make.