Michele Calandro is more than a legal mind for Blue Cross and Blue Shield (BCBS) of Louisiana. She is also a key strategist who is helping the business make all the right moves to grow and meet its ongoing mission.
Over the past two years, BCBS of Louisiana has expanded into new markets, an initiative rooted in the company’s mission to improve the health and lives of all Louisiana residents. But two years ago, that wasn’t necessarily the case.
“Historically, we had only been in the commercial space,” recalls Calandro, executive vice president, chief administrative officer, and general counsel at the organization. “But looking at the demographics of the state, we saw a large number of younger people moving away. The population here is aging.”
About 15 percent of Louisianans were on Medicare, a figure that is trending upward and is currently at roughly 17 percent. Meanwhile, the percentage of the state population at or below the federal poverty line receiving Medicaid was also about 15 percent. When Louisiana expanded Medicaid in July 2016, that percentage almost doubled. But BCBS services weren’t reaching any of these people.
Then, as Medicaid was expanding, BCBS of Louisiana introduced its Medicare Advantage plans under now-retired president and CEO Mike Reitz.
His replacement, Dr. I. Steven Udvarhelyi, quickly saw Medicaid as another opportunity to fulfill the company’s mission and diversify its portfolio of product offerings.
“It was a chance for us to not only provide coverage from cradle to grave, but also through people’s financial life cycle,” Calandro says. “Sometimes your economic status changes. We thought, ‘Let’s look at how we can cover everyone at all times.’”
In December 2016, BCBS of Louisiana signed an agreement with Amerigroup Louisiana, a subsidiary of Anthem, to pursue a Medicaid-focused partnership. Amerigroup Louisiana is a managed care organization that provides services and benefits to about 229,000 members who are part of the state’s Medicaid, Medicaid Expansion, and LaCHIP programs under the state’s Healthy Louisiana Medicaid managed care program. In September 2017, Amerigroup Louisiana rebranded its Louisiana Medicaid plan to Healthy Blue, leveraging the recognition of the Blue Cross and Blue Shield name. The partnership has given BCBS instant market share in Medicaid, a stake it plans to build on in the coming years in collaboration with its partner.
Calandro will figure prominently in those and other developments, particularly under Udvarhelyi’s leadership. He is the fifth CEO Calandro has worked with during her tenure at BCBS of Louisiana.
“He is definitely in the weeds with the rest of us,” Calandro says. “I jokingly call him my co-counsel. He’s been in a lot of areas in this industry and knows about a lot of things. You really have to be on your toes and make sure you’re giving him the right advice. He can definitely second-guess you.”
That has only made Calandro sharper as her role expands along with the business. Once she focused primarily on support functions, such as administrative services and functions that are traditionally in the legal arena. But now, she is called upon to use her financial and business acumen to handle the company’s internal audit and enterprise risk management functions.
In that role, Calandro studies the business, political, and regulatory environments, as well as business opportunities and identifies possible risks. Ultimately, her job is to provide the board and management team with strategies to achieve objectives without opening BCBS to risks that are outside of the company’s tolerance. She recommends risk appetite and tolerance, and the board defines or sets those levels based on Calandro’s recommendations.
Her work in managing the legal and compliance areas has led to many positive developments at BCBS of Louisiana. One example is the organization’s paperless initiative, which aims to reduce expenses, communicate with customers in their preferred medium, and be more environmentally friendly. The organization couldn’t simply demand customers go online to pay their bills and view important messages about their coverage, Calandro says, so she helped the company find alternative ways that fit within the current legal framework. Sometimes, as was the case with telehealth, Calandro works with the state legislature to reshape the legal framework to help BCBS better serve Louisianans.
“We have rural areas where the lack of primary care physicians and behavioral healthcare is a challenge, and telehealth may be a way to solve it,” Calandro explains. “We had an initiative in place, but our laws didn’t allow it to take effect to the extent that would make a real difference in access to these services.”
The main sticking point was the out-of-state locations of many telehealth providers. Louisiana didn’t allow health professionals not physically located in the state to give medical advice to citizens. So, Calandro used her tactical skills to convince legislators to loosen the laws.
“That took a couple of years,” she says. “The Louisiana State Medical Society wasn’t eager to change the laws. They were concerned about being able to ensure a true physician-patient relationship and the quality of services.”
Now, BCBS of Louisiana provides its members and all Louisiana citizens the easy access to healthcare they need. With its solid position in the Medicare and Medicaid markets, BCBS of Louisiana will likely need Calandro to do more work on the legislative front. Given the uncertain future of the Affordable Care Act, this work has become more difficult, she says.
“We work hard to stay in contact with our congressional delegation,” Calandro says. “We meet often with our state’s congressmen and senators. We are also able to leverage the Blue Cross Blue Shield Association’s resources to try to keep one step ahead of legislative and regulatory changes.”
Often, the feedback she gets from these meetings isn’t much to go on. But for Calandro, who brings her strategic, legal, and tactical thinking skills to bear every day, it’s enough to make smart recommendations. The future of BCBS of Louisiana depends on it.
Photo: Jason Cohen