Paul Fearer, senior executive vice president and director of human resources for Union Bank in San Francisco, brings a rich background in health care purchasing to the penultimate seat on the California Health Benefit Exchange board. Now he and his three colleagues are waiting for the fifth and final appointee so the board can set policy in motion in preparation for the exchangeâs start-up in 2014.
He joins California Health and Human Services Secretary Diana Dooley, former California HHS Secretary Kim BelshÃ© and former Schwarzenegger administration chief of staff Susan Kennedy on the exchange board.
“We may look at different ways to reach solutions, but we are aligned in our mission to achieve affordable, quality and accessible health care,” Fearer said.
He is particularly focused on improving quality while constraining costs. “Affordability and quality are not in conflict,” he said. “The right care at the right time is the most affordable care.”
As board chair of the Pacific Business Group on Health, which leverages the health care purchasing power of 50 large employers with three million employees, he knows the drill. The statewide health benefit exchange has its genesis in PBGH, Fearer said. He has learned that the key to success is getting stakeholders to work together and share their ideas and challenges.
“There are many stakeholders with huge economic self-interests and different points of views on what benefits should be provided and how they are designed,” Fearer said. “Our responsibility is to develop criteria for plan participants and performance standards for providing services.”
Fearer also earned his stripes at now defunct PacAdvantage, a statewide health insurance purchasing pool for small business, which he chaired for seven years. And of course, his current position at Union Bank reflects his purchasing expertise as he seeks affordable care for the financial institutionâs employees. Fearer has every right to be a self-proclaimed “expert” in health care purchasing, and colleagues confirm the title.
“Paul understands what it takes to start up an operation, and he has been a purchaser of insurance on behalf of a large company. And he has chaired the Pacific Business Group on Health, which is a large purchaser. It’s just a fabulous appointment,” says John Grgurina, CEO of San Francisco Health Plan.
Fearer said he learned a lot from PacAdvantageÂ — about what works and what doesnât.
“The risk profile of the population being served has to be reasonable to avoid adverse risk selection, a fatal weakness,” he said. “Participating plans in PacAdvantage had become the insurers of last resort, making it economically unfeasible to underwrite individuals.
“You also need a competitive offering; efficient, reliable and accurate operations; and customer service addressing underserved communities. That population is most in need of education and information on eligibility and plan choices, which are complicated issues,” Fearer said.
Finally, the human resources director said the exchange must provide transparent information about plans, providers and coverage options and a robust set of alternatives for individuals so that they can access appropriate care at the right time.
Although theÂ Affordable Care Act sets guidelines for the development of exchanges, Fearer is confident there will be room for tweaking. “The broad range of standards donât preclude innovation,” he said. “Over time, operations developed by the exchange will influence the health care delivery system in California.”
Fearer does not think that California has to create an exchange in a silo, but rather, he envisions collaborating with other states. “There is no need to invest in a unique product,” he said.
(David Gorn is on vacation.)