New head of state's largest health insurer sees broad mandate to improve care, cut costs

The new CEO of Maryland’s largest health insurer wants to explore means of lowering health care costs for all state residents, as well as expanding its own reach through the Medicare and Medicaid government health programs.

Brian D. Pieninck, named president and CEO of CareFirst BlueCross BlueShied as of July, discussed what he aims to achieve heading the carrier in his first expansive remarks to the media.

Many of the ideas are not new, though he saw pursuing them as in sync with the insurer’s not-for-profit mission to improve community health. They also are in line with actions of Pieninck’s predecesor, Chet Burrell, who launched a grant program to fight opioid use and another to promote preventive care through primary care physicians.

Pieninck, for example, he supports the idea of a state mandate requiring Marylanders to buy health insurance to spread risk and lower costs now that the Affordable Care Act’s federal mandate will go unenforced. And he backed shoring up the insurance market by merging small business and individual sectors on state exchanges created under the federal law sometimes called Obamacare.

He plans to pursue permanent funding for a reinsurance program passed this year by the General Assembly that offsets costs incurred by big health care users for the next two years.

But Pieninck, who had been CareFirst’s chief operating officer, also said he intends to help look for ways to go “upstream” in the community to prevent expensive care later. That means tackling societal ills that can lead to poor health and high medical bills.

He also said the health care providers and insurers need to figure out a way to vastly expand drug treatment and mental health care.

All of the moves would require extensive buy-in from lawmakers, providers, other carriers and especially the community, he acknowledged. But he said, “I don’t think we’re the only ones in the community who want to focus this way.”

One area the insurer plans to pursue alone: new customers. CareFirst may seek to enter the Medicare Advantage market by 2021. Those plans provide coverage for seniors through private insurers instead of the government program. CareFirst says this would allow for continuity to consumers who stick with the carrier throughout their lives.

The firm also may seek to enter the market to manage Medicaid for consumers. That’s the federal-state health program for the poor that uses private firms to administer the insurance.

meredith.cohn@baltsun.com

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