2016 Powered by Women
DBusiness readers nominated eight metro Detroit women who hold leading positions in the automotive industry, sponsorships and event planning, health care, logistics, insurance, and nonprofit organizations.
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President and CEO
Priority Health, Grand Rapids
Employees: 1,200 | Revenue: $3B
When she was chief marketing officer for insurer Priority Health, Joan Budden was part of innovations like covering complementary medical practices, using the Health Care Bluebook to help tell beneficiaries what their out-of-pocket costs would be, and offering a rewards program for members who shop around for the best price for a service.
Now that she’s president and CEO of the Grand Rapids-based nonprofit health plan, expect more changes to come. “I like change, I thrive on it,” Budden says. “Keep trying new things, that’s how the world gets better.”
After she became CEO in January, Budden made a point to address how Priority Health is doing in the post-Affordable Care Act world. “I was pleasantly surprised about what I heard, and I also learned a lot,” she says. “As an industry, health care is facing a lot of challenges, (one of which is) that it’s simply unaffordable and people need solutions.”
Employers, in particular, believe they have few choices and are frustrated with escalating health care costs, Budden notes. They want to see increased rivalry among insurers. “Competition increases innovation,” she says. “The ACA has improved competition and made it more accessible for people to shop and compare things on the basis of facts, so there’s a lot of transparency about prices today.”
The ACA has been good for Priority Health’s business. The insurance company’s market share among individuals statewide who buy their own insurance has risen to 20 percent from 5 percent since the act took effect in 2010, Budden says.
Among seniors who buy Medicare Advantage coverage, a fee-for-service model, 54 percent statewide are covered through Priority Health. Of the approximately 725,000 Priority beneficiaries in Michigan, about 390,000 receive coverage through their employer, 125,000 have Medicare Advantage, 110,000 buy their own insurance, and 100,000 are Medicaid recipients.
Looking to the future, Budden says Michiganders can look for Priority to make coverage and services more affordable, while increasing beneficiaries’ access to health care. “I believe affordability is the biggest challenge we face,” she says. “I think I’m a champion on this.”
Budden has her focus on changes in the payment structure that favors paying for high-quality outcomes; rendering services at alternative sites of care, including in the patient’s home; and offering preventive care that’s more cost-effective.
“For one inpatient stay, you could have about 200 office visits,” Budden says. “So why not offer people more access to their physician?”
Also related to preventive care, Priority recently released results of a five-year study of 9,000 beneficiaries that did a head-to-head comparison of the prevalence of chronic conditions and costs between participants and nonparticipants in its HealthbyChoice program. The workplace program is designed to raise awareness of potential health risks and reward employees for making measurable progress toward being healthier.
The study results showed HealthbyChoice saved employers up to 12 percent in claims costs, or $1.2 million over four years. Over five years, there was a 25-percent drop in the development of diseases such as diabetes, chronic lung disease, and heart disease related to a decrease in blood flow to that vital organ.
Also look for Budden to tackle problems in individual coverage, where premiums industrywide have doubled since the ACA took effect. “People who enroll during special enrollment are entering the market when they’re in need of services, but not entering when they don’t need them,” she says, adding penalties may need to be put in place to level out the playing field.
To boost access to health care, last year Priority Health started offering telemedicine mental health services in rural areas where such practitioners are scarce. “I really believe that, as a society, we need to make health care work,” she says. “It’s an underpinning of who we are.” — Ilene Wolff