The Exec: Getting Real with CareFirst President and CEO Brian Pieninck

The Blues executive outlines the broader role that health plans and their leaders must play for equitable economic growth.

Smart leaders navigate challenges with more questions than answers.

Brian Pieninck, president and CEO of CareFirst BlueCross BlueShield, is one of those leaders.

That made HealthLeaders' exclusive interview with Pieninck a balance of the personal and the professional. Topics ranged from critical pandemic lessons that the healthcare industry can't afford to leave behind, to broader regional investments that make CareFirst and its executive a leader in areas that reach far beyond traditional healthcare.

The conversation started with the social determinants of health (SDOH), a term as problematic as the challenges it hopes to spotlight.

Reframing healthcare's language and focus

"The way we talk about SDOH feels so far from how people wake up every day in their own lives," said Pieninck. "A determinant feels like something that's destined to happen, and I don't think that's right. We need to make choices—as a society, as an industry—that help us intervene in better, more thoughtful, more effective ways."

Focusing on supply over demand—i.e., putting healthcare's consumers first instead of its delivery mechanisms—is another area the industry should reevaluate, said Pieninck.

"I would argue that if we're going to get this right, we need to start with the demand side, the people whose lives we're trying to impact."

Critical learnings from the pandemic

Nothing changes paradigms quite like a pandemic. The question is, will those changes last?

Pieninck hopes so, noting that "a global health crisis is something that most of us professionally had never seen" and the few simple lessons that he now reflects on often.

"One is humility. Most of the things we'd been doing in healthcare delivery were not really effective in the early days of a rapidly progressing pandemic. All of us were forced to confront that. The humility of that is something I'm desperately hoping will continue in healthcare as we go forward."

"The second is collaboration. I saw so many organizations across healthcare being willing to sit down in new ways, to connect and ask questions: How can we set aside the historical definitions of who we are and the roles we play and look at things more practically? What's going to drive the best progress? What can we do in partnership with the hospital, the health department, with local resources and communities that will create the change we so desperately need under these difficult circumstances?" said Pieninck, illustrating the "leading with questions" approach that characterized his discussion with HealthLeaders.

"That thoughtfulness—that we're all connected in this ecosystem that is healthcare—was a critical learning that I'm really hoping we don't lose sight of."

A third lesson from the CareFirst executive? That "healthcare interventions are not limited to healthcare resources."

"What worked out of necessity during COVID is, more often than not, what works when we're trying to reach people every day. There's a level of thoughtfulness and personalization that so often gets missed in trying to deliver in a healthcare system," said Pieninck, adding: "I would really love to see us continue to invest, scale, and stretch impact in areas that we have traditionally thought of as being outside of the healthcare ecosystem."

Brian Pieninck, president and CEO, CareFirst BlueCross BlueShield. Photo courtesy of CareFirst BlueCross BlueShield.

How a leader shows up

Pieninck on how he leads, as a professional and as a person: "For me, I really can't separate the two. Regardless of where I am in the community and given the role that CareFirst plays in the city, in the state, in the region, there isn't a moment in my life where I'm not the CEO of CareFirst. There really is no separating Brian at home and Brian at work. That's opened up more opportunities to extend our reach."

CareFirst BlueCross BlueShield is the largest not-for-profit health plan in the Mid-Atlantic region. It serves 3.6 million commercial, group, government, and students members across Maryland, Washington, D.C. and Northern Virginia.

"People may look at CareFirst and say, 'Hey, you're a health benefits company. Why are you personally committed to transportation in this region?' But when you start to speak in terms of, 'Yes I'm a representative of CareFirst. But I also work here and live here, and my family is growing up here.' So what's happening here affects me not just professionally, but personally."

Regional health, growth and prosperity

CareFirst's role in regional transportation improvement brought the discussion back to equity—health and otherwise.

Pieninck said: "I'm sitting here today in Baltimore City. If you live in the greater Baltimore region and you want to get to pretty much any job and you own a car, you're in luck. You can get there within one hour, no problem."

"But if you're relying on public transportation, you can only get to 9% of those opportunities," he noted. "You look at that and say to yourself, 'Here we are as an industry, trying to have a conversation with someone about managing their diabetes, and that person might be waking up every single day already behind the rest of the people in the community because they can't get to 91% of the opportunities.'"

Balancing short and long-term solutions

Expanding the discussion from transportation to pandemic work changes, Pieninck added: "There's so much conversation about this idea that we moved to remote work during the pandemic. And the reality is that for a huge percentage of people, that was never true."

"If we design things in healthcare that only serve the needs of a small number of people, we are not going to get to the right structure and solutions for broader populations and the public at large. That is the thing that healthcare needs to confront."

Pieninck added more detail on his plan's approach to regional growth.

"CareFirst is heavily invested in a multisector transportation investment initiative for the mid-Atlantic region—from Richmond north to Baltimore and everything in between. That's likely going to take a decade or more to mature, and those options are critical to getting it right into the future. But they don't necessarily help people right now.

"As a company, what we've said is: How do we advocate for the long term—making sure that we get things increasingly right structurally and what are some things that we can also do differently right now that begin to change the trajectory of people's lives and local communities? From that perspective, large anchor institutions like ours start to solution differently."

Making a broader impact

Pieninck concluded the discussion with a broader look at what healthcare needs to improve.

"I see this as a really critical moment where, as an industry and as society, we're pressing toward the convergence of doing what's right and doing what's smart," said the CareFirst exec.

"The trajectory that healthcare has been on is just not sustainable. We have a $23.3 trillion economy in the United States and 18.3% of that is healthcare spend. We have to reconcile that we're not getting the outcomes, impact, and benefit based on the level of investment. Most other industries would be maniacally focused on that.

"We've got to reorient that spend. We've got to get upstream. We can't just think about what we do as symptomatic relief for the manifestation of disease. We've really got to think about the health, quality of life, and economics of this country."