Q&A with Brian Keller, chief marketing officer at Blue Cross and

New Orleans CityBusiness, Jun 2, 2009 by Richard A Webster

Brian Keller has been promoted to senior vice president and chief marketing officer at Blue Cross and Blue Shield of Louisiana. Keller, who has been with the company since 1996, is a New Orleans native and a graduate of Tulane University's A.B. Freeman School of Business.

He discusses the future of health care coverage in New Orleans.

What role has the insurance companies played in the rising costs of health

care?

"The industry ruined itself when years ago we introduced HMOs and gave everyone co-pays saying, 'This is the route you go.' Doing that we lost the transparency of what things cost. If you're on a co-pay you don't care if the x-ray you're getting costs $200 at one place and $500 at another because all you have to do is pay $20.

"We've taken the consumer out of medical care completely. If you have a high deductible, however, you become better aware of what things cost and that can have a positive effect. We need to move to a consumer model for the little things so you can make decisions that are financially better for you. That way you save yourself money and also the insurance company and employer.

"My role will be pushing for transparency, working with hospitals and doctors and pharmaceutical vendors to share this information so people know what things cost and can make better decisions."

What are some of the main obstacles so far as reducing the ranks of the uninsured?

"People in Louisiana can get quality care for free so it's difficult in talking people into getting insurance. If they get into an accident or are severely ill now, they can always go to a hospital and receive free treatment. Unless there's a huge systemic shift in how we fund health care for the uninsured, we'll always have a fairly severe uninsured population.

"You also have a certain percentage of the population who can't afford insurance but make too much money for Medicaid. And then you have the 20-year-olds, or as we call them, the Invincibles who feel 10-feet tall and bulletproof. They can afford insurance and it's extremely affordable. A

20-year-old male can get great coverage for $100 a month, but they may see

that as four cases of beer or two nights out. So they decide against insurance since nothing is going to go wrong anyway.

"We need to market directly to them. I guess I need to learn how to Twitter and Facebook."

How can New Orleans decrease its health care costs?

"We need to focus more on wellness. We live by the 80/20 rule -- 20 percent of our members spend over 80 percent of our health care dollars because they don't take care of themselves. The real savings is trying to keep other 80 percent from moving into the 20 percentile range.

"Louisiana is No. 1 in the country diabetes, No. 2 in heart disease and in the top five in cholesterol. It's our food and lifestyle. There are a lot of health care dollars that aren't accident related and are conditions we bring on ourselves.

"We can push harder to put more wellness things in place so people can keep themselves healthier."

How has Blue Cross Blue Shield encouraged its own employees to embrace better health and wellness?

"We pushed health fairs and tests and we got pitiful participation, even though we're a health insurance company. So we said if you don't participate, you'll pay an extra $25 a month for insurance. So now we have 98 percent participation, up from 20 percent. The stick worked better than the carrot.

"It was either show up four times a year to a health fair, visit a wellness coach and have your glucose and blood pressure checked, or pay more per month. And it really made a difference.

"People didn't realize they were borderline diabetic or hypertensive. People said, 'I do need to take better care of myself, watch what I eat and go to a doctor.' It's the awareness portion of it.

"So now we can take what we've done to our own employees and make a push to our larger employers."