The Exec: 'You Need Naysayers' Says Geisinger Health Plan's President

"It's important to not rely on just one data view," notes Kurt Wrobel, who has helmed the integrated delivery network's payer business since 2020.

Editor's note: This article appears in the June 2023 edition of HealthLeaders magazine.

"There are a few of us out there," says Kurt Wrobel, referring to the actuaries who now lead U.S. health plans.

Wrobel's trajectory from chief actuary to CFO to president of Geisinger Health Plan (GHP) is fairly unique, making him quick to recognize others in the field. ("There's also Krista Hoglund, the CEO of Security Health Plan.")

But every executive journey is distinct, including Wrobel's leading a Pennsylvania payer that serves approximately 500,000 Medicare Advantage, Medicaid, CHIP, Marketplace, and employer group members.

In an exclusive interview with HealthLeaders, Wrobel detailed leadership transitions during disruption, healthcare reform's impact on actuarial science, and why it's important to question data.

From chief actuary to president

"I started my career in large-group pricing and underwriting for larger insurers [PacifiCare Health System, UnitedHealth Group, and Humana]. It's a great way to get the details on a particular line of business, but a smaller organization can give you a broad vantage point across all lines of business. As an actuary, you touch a lot of details and get a breadth of experience across all lines of business that you wouldn't necessarily get in other professions or organizations."

Leading during disruption

Wrobel transitioned to the top position at GHP at a particularly challenging time.

"I became interim president at Geisinger at the start of COVID when no one was around. The chief sales officer and COO had left and it took a while to fill those roles, including the chief actuary and CFO role I had held," says Wrobel, adding: "I wore those two hats, as well as president, for about nine months. There was a lot going on. The downside is you have to be a little less forward-thinking while you're getting problems solved."

Wrobel is quick to recognize the problems others were solving.

"I'd add that what I went through isn't anywhere near what the nurses and physicians went through during COVID. The way they came together—I have so much respect for them and their connection to one another and the community."

Pictured: Kurt Wrobel, president of Geisinger Health Plan. Photo courtesy of Geisinger.

How healthcare reform changed actuarial science

An actuary since the mid-1990s, Wrobel has an insider's perspective on how the Affordable Care Act impacted not only his profession but the healthcare industry at large.

"Where the profession had historically been focused on life and pension, health insurance has become increasingly more important. The actuary's role in healthcare has grown because the industry is more complex and now more oriented to risk."

Wrobel adds: "I somewhat joke that the Affordable Care Act and value-based care made actuaries too important. The ACA and VBC introduced more uncertainty and increased the need for actuaries in healthcare."

Case and point: risk adjustment.

"Risk adjustment post contract is difficult. It's hard to get a sense of true performance, risk scores, risk payments, and to establish liability—especially in the early years of the ACA. It's good that it's become calmer compared to the early days of the ACA. There's more data."

Data isn't everything

Wrobel identifies himself as a "believer in using wisdom and simple data analysis to answer business questions." He has written extensively on the need for, and power of, simplicity in complex fields—from actuarial science to insurance to healthcare.  

It takes more than data, and certainly more than one view of it, to not only arrive at the best decisions but frame the best questions. 

"There is the promise of Big Data and the industry that has grown up around it," says Wrobel.

"There are people who have the incentive to push more data on an organization. It's important to not rely on just one data view, but look at different sources, the marketplace and benchmarks."

Wrobel adds: "People can fall in love with a story and then seek the data to support it. It's called narrative bias. It's human nature but there's a real danger—think of Vietnam as well as how data is used incorrectly in elections. You need naysayers who will take a different position. Discipline around this is critical."

Wrobel has written about not only narrative bias but the many other blind spots that leaders can fall prey to—whether they are from technical or nontechnical backgrounds or make decisions in the arenas of war, finance, politics, or healthcare.

Wrobel is aware of this in his role as GHP's president as he balances his actuarial background with the health plan's mission and vision, noting: "You still want to dive into the details, but the worst thing is to get caught up in them. You're the leader of a broad organization who needs to manage people and strategy. I have to catch myself at times and have learned to trust the team to get the details right."

Payers and providers: The state of the union

Many healthcare conversations seem to touch on payer-provider relations. Challenges abound, even for IDNs, but Wrobel is optimistic.

"It's true that at Geisinger, we take a different perspective. We view providers as key partners, very much so, in creating risk-based arrangements and aligning incentives."

Success lies in a common purpose.

"We're all trying to do the same thing: deliver high-quality, affordable care," says Wrobel. "It's in our DNA and is becoming part of the DNA of other payers and providers. There is some thaw in those relationships, especially as payer and provider roles have become more interchangeable and represent more financial challenges."

The GHP president adds: "Anything that moves us from fee-for-service [FFS] and toward greater alignment is a positive."

"Like moving an aircraft carrier"

Wrobel expands on the evolution from FFS to value-based care, noting the need for, yet difficulty, of change to healthcare's reimbursement framework.

"The economic incentive that's important is moving away from traditional FFS. Two of the biggest developments here are the increasing complexity of the individual, group, and Medicare Advantage markets and the move toward value-based care."

Wrobel adds: "Everyone knew we didn't have a great, sustainable system. The move to VBC has been steady but slower than expected because healthcare is complex—like moving an aircraft carrier. You can't change hospital, physician, and payer behavior on a dime."

"Hospitals are important"

As the leader of a health plan closely integrated with its providers, Wrobel holds Geisinger's hospitals in high regard.

"Hospitals are important. I fully understand their challenges but have respect for what hospitals and health systems do. It's not just about saving money or the number of value-based contracts you have," says Wrobel.

He adds: "Hospitals are the jewel of many communities. Yes, we need to become more efficient. But few industries provide something more important than healthcare. There is simply no comparison."