As an executive of WellPoint and its top doctor, Sam Nussbaum’s image is a balancing act that belies his stern focus on improving the lives of the health insurer’s 35 million members
With a slight laugh, Dr. Samuel Nussbaum admits some fellow physicians don’t quite get his career change — from medical school professor to health insurance executive.
"The ‘dark side’ is the expression that my colleagues use," said Nussbaum, chief medical officer of Indianapolis-based health insurance giant WellPoint.
Yet Nussbaum sees his work at WellPoint as a chance to improve the care of the company’s 35 million members through better coordination of services and by rewarding physicians whose patients have improved outcomes.
"I loved the discovery. I loved the teaching. There’s no higher calling than to teach the next generation," he said.
Yet he derives a different satisfaction in the insurance industry, working with government and health providers, Nussbaum said. "We’ve seen the power of what the private sector working with doctors can do."
That message — of insurers, government and health providers working together — is one being touted by WellPoint, with the anticipation that President Barack Obama will push for reform of the costly and complex health-care industry.
Look for Nussbaum to be at the center of that debate, as WellPoint faces potentially huge changes because of national health-care reform, all while trying to rebound from its disappointing financial performance in 2008.
WellPoint Chief Executive Officer Angela Braly says Nussbaum will make sure WellPoint’s medical policy is in line with scientific evidence.
"Sam has… done it all," Braly said. "He was a practicing physician. He was a researcher. He taught at Harvard and Mass General."
Leading new initiatives
Initiatives spearheaded by Nussbaum and his team include WellPoint’s Member Health Index — a program that measures whether members are getting recommended care, such as cholesterol tests and cancer screenings.
The performance of that index is tied to bonuses received by every employee. The index also is used to help guide care.
For example, WellPoint studied whether members hospitalized for serious mental illness received recommended followup outpatient services. Staff members called them to help schedule those appointments. In 2008, such followup visits by patients increased by 27 percent, according to WellPoint.
Nussbaum recognizes there will be criticism as he looks at ways to improve care and outcome. Large for-profit insurers are a frequent target in discussions about changes in the health-care industry.
"The idea that we would want a private company that has a profit motive to be the arbiter of what is necessary and unnecessary care, that’s almost a joke," said Jerry Flanagan, health-care policy director at Consumer Watchdog, a California-based consumer rights group.
Some doctors voice similar concerns.
Dr. Ezekiel Emanuel — a former student of Nussbaum’s who is now with the National Institutes of Health — said the insurance industry "isn’t anyone’s favorite."
Yet he said health insurers play an important role in health reform. "You have to change it at every level," said Emanuel, chair of the Department of Bioethics at the Clinical Center of NIH.
"I’m greatly reassured people like Sam are doing good work from that angle," he said.
He said Nussbaum has a knack for explaining complex scientific concepts and how they relate to actual patient care — a gift, he said, not every medical school professor possesses.
For Nussbaum, the intertwining of medicine, business and politics has become familiar territory.
A love of science took hold as he grew up in Kingston, N.Y. His father was a chemist, his uncle a doctor.
Nussbaum earned his medical degree at the Mount Sinai School of Medicine in New York City. He eventually went to work for Harvard and Massachusetts General Hospital, where he directed the endocrine clinical group. He also worked for BJC Health System, a nonprofit group in St. Louis.
Dr. D. Craig Brater, dean of the Indiana University School of Medicine, was struck by Nussbaum’s extensive background in health information when the two served on a committee at the Regenstrief Institute, an Indianapolis-based nonprofit health research organization.
"It’s clear to me that he is an extraordinary thinker and just an extraordinary human being," Brater said.
Yet Brater also talks of the fractious relationship between health providers and insurers: the "nit-picking" of doctors having to fill out form after form to justify care, and the reimbursement disputes with insurers that often leave patients caught in the middle.
Another view
Jeff Nussbaum calls his father, Sam, demanding but nurturing.
"He was pretty rigorous in making sure I got my math homework done," said the younger Nussbaum, 33. "We would only get to throw the baseball around in the yard once the homework was done."
TV was limited to one hour a week — except news and nature programs.
The younger Nussbaum’s role as a speech writer for Vice President Joe Biden during last year’s presidential campaign created some awkward moments.
"There have been times on the campaign trail for different candidates where we would rail against insurance company bureaucrats," said Nussbaum, a partner with West Wing Writers, a communications company.
But he knows his father is passionate about using resources of a big insurance company to improve quality of care.
"When it comes to health care, most people these days would acknowledge that we need good ideas wherever we can get them," said Nussbaum’s son. "Once you get beyond this sort of surface positioning, especially now, there’s something to be learned from the folks running the insurance companies."
Samuel Nussbaum, a loyal Democrat, talks openly about voting for Obama. He favors embryonic stem cell research — opposed by many social conservatives because it involves destruction of human embryos.
And he continues to support Obama, even though Obama has taken shots at health insurers. The White House Web site pledges health reform that "makes insurance companies accountable."
Obama also has proposed a public health plan that would compete with private insurance through a new National Health Insurance Exchange.
Consumer Advocate Flanagan said such a plan could spell trouble for WellPoint and its peers because of the higher overhead costs of for-profit insurers.
Flannigan said a public-plan option being touted by Obama could save consumers money. He pointed to a University of California-Berkeley report that cited Medicare as having overhead administration costs of around 3 percent, compared with overhead of 25 percent to 27 percent of premiums in the small-group insurance market.
WellPoint, though, opposes such a public-plan option, saying it would do less to coordinate care and improve its quality — the sorts of things Nussbaum advocates.
But as differences get sorted out, Nussbaum sees plenty of opportunities to improve care.
"This industry is undergoing a transformation," he said, "and I think that transformation is absolutely right."
Additional Facts
SAMUEL NUSSBAUM
» Title: Executive vice president of clinical health policy and chief medical officer, WellPoint.
» Role: Oversees corporate medical policy, clinical pharmacy operations and health improvement programs.
» Compensation: Not disclosed by WellPoint.
» Residences: St. Louis and Indianapolis.
» Education: Medical degree from Mount Sinai School of Medicine; trained at Stanford University, Harvard University, Massachusetts General.
» Career highlights: Directed endocrine clinical group at Massachusetts General Hospital; executive vice president of BJC Health System.
» Family: Wife, Rhoda; three adult children.
» Personal: Loyal Democat and Obama supporter; enjoys running; collects pictures and figures of lions.
NUSSBAUM’S THOUGHTS ON HEALTH-CARE REIMBURSEMENT:
» Primary-care physicians do not receive enough financial reward for helping patients manage chronic diseases such as diabetes. He points to WellPoint’s pay-for- performance programs to increase pay for doctors whose patients receive recommended care.
» There is over-reimbursement for many high-tech medical imaging scans, such as MRIs. He points to WellPoint’s American Imaging Management business, which uses software to scrutinize whether scans are medically necessary.
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