Share ThisOur vision is a world where everyone embraces health. In our Remarkable Leadership series, we talk with people who are making that vision a reality by leading the work to create a new system of health, empower our customers and communities, and better support every individual’s health journey.
For Bruce Meyer, MD, MBA, everything the long-time obstetrician-gynecologist thought he knew about medicine changed in 2000 — the year his wife, Christie Little, MD, was diagnosed with cancer.
All the years of medical training and clinical experience that he and his wife, also an OB-GYN, had acquired seemed inadequate in the face of their own medical crisis. Back then, the five-year survival rate for fibrosarcoma, a soft-tissue cancer of the extremities, was about 50%.
“It was a profound experience. For one thing, we had five children under the age of 11 at the time,” explains Dr. Meyer, the Western PA Market president for Highmark Health. But beyond the obvious life-and-death concerns, Dr. Meyer and Dr. Little soon came to realize that the health care system is a lot better at treating the disease than it is treating the patient and their families.
“They didn't think about how it impacted my wife’s life, how it impacted my life, how it impacted our children’s lives,” Dr. Meyer says.
Two decades later, Dr. Little remains cancer-free, but the experience gave Dr. Meyer valuable insight into what the health care system does well — and where it falls glaringly short.
“One of the great things about the Allegheny Health Network is it’s a place where we take care of the person who has a disease, and not just the disease itself,” he says.
Bill Toland: Why do you think our national health care system has developed in the way that it has — good at treating specific conditions, but not as good at treating the whole person?
Dr. Bruce Meyer: The system is really built around the doctor-centric model. We make people come to the doctor, and the doctor has sort of a paternalistic relationship with patients. They tell them what to do and then patients follow those instructions. But not surprisingly, people don't or can’t always follow those instructions. And for a very long time, we didn’t consider why that was.
Bill Toland: And why is that?
Dr. Bruce Meyer: There are social determinants of health that create barriers that prevent people from following instructions, as well as financial barriers, family barriers, and so on.
We also don’t always practice medicine in real-world settings. I think one of the interesting things to me is the ludicrous way we screen for hypertension — we have you come to our artificial environment, our office, where everybody’s in a white coat, and we take your blood pressure a couple, three times a year, and then we derive all your therapy from that very artificial environment.
If we were better about thinking of patients as people, and considered how their environment might affect their health, we’d be taking your blood pressure at work, or at home when you’re playing with your kids — we would understand how your blood pressure reading varies during the day, and then guiding therapy based on those readings.
Bill Toland: Are we getting better at that?
Dr. Bruce Meyer: Definitely. The pandemic was a big piece of this, and it forced our industry to think about how we provide health care where you are, where you need it, and when you need it. As opposed to — hey, you've got to find your way through the challenges of the system, the barriers that we put in front of people in order to get an appointment, to get through on the phone, to find the right doctor.
Obviously, there have been huge advancements in medicine over the last 20 years — different therapies, new knowledge — which is great, but those things are all geared at treating the disease. I think the most exciting advancements are in the way that we now understand that we have to treat the whole person, and we have to treat the environment in which that person is receiving care in a substantive way — that’s where things have started to really change.
Are we where we need to be? Categorically no. So there's tons of opportunity.
But have we at least recognized the needs of the people and the communities that we are caring for? I think we've recognized that now. What we now need to understand is how we incorporate that awareness into the care that we give. And candidly, this is why I'm here at Highmark Health — trying to find better ways to provide that care, and pay for that care.
Dr. Bruce Meyer: Sure, Bruce Meyer, father of seven, husband of 36 years.
I'm a physician obstetrician by training, maternal fetal medicine by subspecialty. And I'm the president of the western market for Highmark Health and an executive vice president here at the company.
When my wife was diagnosed with cancer in the year 2000, it was a pretty scary time. At the time we had five children under the age of 11. And her survival rates for the type of cancer that she had was 50/50 in five years. So that was a sobering moment. And the experience of her care and going through that, even the information around the diagnosis, really made me realize that what medicine was geared at was not at the experience of all of the people who surround the individual who has an illness, but just of that individual and sometimes just of that illness.
I've talked a lot with peers, and even since I've arrived — one of the great things I think about the Allegheny Health Network is it's a place where we take care of the person who has a disease and not just the disease itself.
I think we have moved profoundly, and the pandemic was a piece of this, into thinking about how do we provide health care where you are, where you need it, and when you need it, as opposed to hey, you've got to find your way through the challenges of the system, the barriers that we put in front of people in order to get an appointment and get through on the phone, find the right doctor to provide the care, you know, do parking, do wayfinding, sit in the office waiting for and then get your care, and then exit and do all those things in reverse. And remember all the things that we told you so you can tell your loved one at home, ‘This is what they told me,’ and then follow all the directions, which even though we oftentimes give you a piece of paper that has those things on it, that piece of paper is typically written in what I call doctor speak, right? It's the way we think of medicine and how we were trained in medical school or in nursing school, about phraseology and language and the names of different kinds of conditions, as opposed to a way that someone who is a layperson who's not trained in the medical field can actually understand what's going on.
The classic example of that is if I tell you that you have idiopathic thrombocytopenic purpura, that sounds terrifying. But if I said, you bruise really easily, and we don't really know why you bruise really easily, that's what the diagnosis is. It can be more complex than that, but most of the time, that's what it is. That's a very different kind of experience of care just in that small phraseology, and if I write that on a piece of paper, it's even more intimidating.
We have found that some of our diabetics who have a very high hemoglobin A1C, which is a measure of how much blood sugar you have, over time, have it because they didn't have a working refrigerator, so they couldn't keep their insulin cold. So their insulin didn't work. And it's much cheaper, much much cheaper to pay for a refrigerator in that person's home, than it is to pay for all a sequela of uncontrolled diabetes over time.
The way I envision us working better together both from a plan and a provider side really comes in three categories. The first category is really the data. Historically, we have kind of been very, very regimented about keeping plan data away from provider data. So providers have all the clinical care data and plans have all of the claims data. Being able to blend that piece of information so that we can identify people who are at risk and intervene before they wind up in an ER or wind up in a hospital is really probably our most profound opportunity. If we're going to really get at the roots of why it's so expensive to receive care here in America, we got to get upstream. One of the problems of the American health care system I talk about all the time is it's really more about illness because that's when we intervene, and it's not very systematic. And I think what we have at Highmark and AHN is truly the opportunity to blend those pieces of data to be able to look at not just people who are currently ill, but look at people who have impending risk, because we have algorithms and we can create algorithms by combining those data to be able to say, this is the rising risk population and let's intervene on them before they find themselves having to go to an emergency room, having to come to a doctor's office with a severe problem or wind up in a hospital where we have to treat them or do some kind of procedure or intervention in order to get them treated.
I think one of the attractive things about Highmark for me is in fact the Living Health model — the idea that we can really try to reach people and allow them to live their best life without their disease interfering with their ability to live their best life, but more importantly, trying to reach people so that we can prevent illnesses and so that we can prevent exacerbations of chronic diseases. That Living Health model that says, hey, let's look at you where you are, where you live, where you work, and those kinds of situations, and let’s work with you in those contexts as opposed to coming to the office or the hospital or the ER and try to work with you in those contexts — to me that's incredibly, incredibly powerful. And I think that is the beginning of the differentiator between what Highmark and Allegheny Health Network are doing together compared to other organizations.
The challenge that’s different, I think, in Pittsburgh, and it is something I think that we're deeply committed to, which is just to think more about the regional referral model and not the hub and spoke model, which is the traditional way to have an ecosystem where you have a quaternary center and lots of stuff gets shipped into that quaternary center. That creates a barrier and a hardship for a lot of people in the Greater Pittsburgh area. And we're committed to these regional referral center structures where you can get care close to home, you can do primary care. I talk with the team a lot about what we're looking for is sort of primary care that’s within 10 or 12 minutes drive of your house or place of business, specialty care that’s within 15 or 20 minutes. And then truly quaternary things, because they’re so resource intensive — but it’s gonna be a short list — can only be done in small selected areas. But let's push as much of that into that regional referral model as we can. So that's a very, very short list that's truly only done at one site inside the network.
Oh, it's the family of nine for sure.
Bill Toland: Let’s talk about your role. As Western PA Market president, you lead the organization’s western Pennsylvania insurance business as well as its provider arm. How do you envision the health plan and the provider working together?
Dr. Bruce Meyer: Right now, part of the challenge in the system is what we have traditionally paid for — when you do stuff to people, you get paid more. And when you talk to people about things, you get paid, but you get paid less. So when we as providers are trying to figure out how to help people in a way that doesn’t involve a procedure or a hospital visit — with housing or with food insecurity, say, which may be exacerbating their hypertension — that isn't really something that the insurance company pays for.
So we have an incredible opportunity with our blended health organization to figure out that puzzle, intervening in such a way that it actually improves the patient’s quality of life, helps them be compliant with their treatment regimens, and helps them live their best life.
We can also work together by sharing data more effectively. Historically, we have kind of been very, very regimented about keeping health plan data away from provider data. So providers have all the clinical care data, and health plans have all of the claims data. But being able to blend that information so that we can identify people who are at risk, get upstream, and intervene before they wind up in an ER or wind up in a hospital, is probably our most acute opportunity if we're going to drive down costs.
Bill Toland: Aren’t all providers trying to bend that cost curve and get ahead of chronic conditions? Do we have a specific value proposition or secret sauce?
Dr. Bruce Meyer: There’s true power in our Living Health model. I wouldn’t be here if I didn’t believe that.
By working together, we can eliminate some of the natural friction between provider and health plan that often leads to increased cost. Obviously, all providers say they want to prevent illness. But for providers, the unfortunate truth is that when we prevent illness, what we’re also doing is diverting revenue that would normally be accumulated in an acute care setting.
That doesn’t matter if our provider and health plan are truly blended. For example, on the provider side, I’d love to remove as many people as possible from the emergency department, and have them do a virtual visit if it’s clinically appropriate. The problem is, the provider gets, say, $100 from the insurer for that virtual visit, but $1,500 for an in-person ER visit. So every time we successfully divert an ER patient, we are scavenging the hospital’s revenue stream. How do they replace that?
If you’re a separate provider, the math doesn’t work. But under the Living Health model, where the performance of our health network and insurance product are intertwined, we can work on that financial equation in real time. Even if ED volume is scavenged, by working together, we can ensure that enough value is returned to the provider so that they can continue to pay for their complex infrastructure and clinical programs. That’s how we’re different.
Bill Toland: You’ve worked in a few different markets now — Philadelphia most recently, Dallas before that. What has been the biggest surprise about the Pittsburgh health care market?
Dr. Bruce Meyer: Every market is different in its own way. One of the unique things about Pittsburgh is that nobody wants to travel through a tunnel, go across a bridge or go over a mountain to get any care. We have a lot of microenvironments where people prefer to receive their care.
So the challenge in Pittsburgh is that we don’t want to use the same old hub-and-spoke model, where we send people to our quaternary facilities in the city for most major problems. That creates a barrier and a hardship for a lot of people in the greater Pittsburgh area.
Instead, we’re deeply committed to the regional referral model, where you can get care close to home — primary care that's within 10 or 12 minutes of your house, and most specialty care services within 15 or 20 minutes. And then the quaternary care is reserved for the most resource-intensive interventions or procedures. But we want that to be a very, very short list — we want to push as much care as we can into that regional referral model.
Bill Toland: You were a physician executive prior to coming to Pittsburgh, but this role marks the first time that you are fully an executive, without a clinical practice. What’s the hardest part about not seeing patients anymore?
Dr. Bruce Meyer: As a practicing clinician, you kind of go home every day feeling like you did something good for somebody. My kids used to joke, “So what did you do today? How many babies did you deliver today, Dad?” And I could say, “Well, this is how many babies I delivered today, or I didn't deliver a baby today, but I did this cool thing for this one family.”
In an executive role, you’re still doing cool things and helping people, but it’s kind of delayed gratification — doing something for the greater good, for the largest number of people, as opposed to folks I can touch directly. That’s the challenge, but also the tremendous reward of this kind of role.
Bill Toland: You mentioned your kids. What’s harder — running a health system, or a family of nine?
Dr. Meyer: Oh, it's the family of nine for sure.
Bruce Meyer, MD, MBA, was seemingly destined to be a physician, given the way that medicine and psychiatry run up and down his family tree.
But initially, he resisted the family calling, turning to acting in high school.
“When I was young, I thought I was going to be the next Dustin Hoffman,” he says. “When I said I was going to New York to be an actor, I was kind of disowned.”
Those Big Apple dreams eventually gave way to undergraduate studies at the University of Texas at Austin, and the seventh-generation physician (his great-great grandfather, grandfather, father, brother and daughter are all psychiatrists) soon made his way into medical school.
The acting bug, meanwhile, eventually gave way to his family philosophy of tikkun olam — the Jewish concept of repairing the world by doing something meaningful with your gifts.
“We talked about that a lot when I was growing up,” he says. “That’s part of your job in the world, to repair it through action and purpose.”
A father of seven — five adult children, with two still at home — and married for 36 years, Dr. Meyer joined Highmark Health in late 2022 after serving as president of Jefferson Health in Philadelphia and senior executive vice president of Thomas Jefferson University.
Previously he worked at UT Southwestern as its executive vice president for health system affairs and in other leadership positions; at UMass Memorial Medical Group and UMass Memorial Health Center as its chair of obstetrics and gynecology; and at Stony Brook University Medical Center in New York.
An obstetrician-gynecologist with a subspeciality in maternal-fetal medicine, Dr. Meyer received his medical degree from UT Health Science Center at San Antonio and his MBA from the University of Tennessee. He completed his residency and subsequent fellowship at Memorial Hermann Hospital in Houston, part of the University of Texas health system.
Want to learn more about Highmark Health's work to create a remarkable health experience through its Living Health strategy? Check out our Living Health Insights and Updates gallery page. Powered by UpContent, our gallery page provides a curated, regularly updated set of some of the best available articles, interviews, webinars, and other content about Living Health and related developments in our industry.
Highmark Health and its subsidiaries and affiliates comprise a national blended health organization that employs more than 42,000 people and serves millions of Americans across the country.
Entire contents © Highmark Health. All Rights Reserved.
Highmark Health is an independent licensee of the Blue Cross Blue Shield Association.
Need to find info about providers, prescriptions, coverage, claims, ID cards, or health spending or savings accounts? If so, your Highmark member site is the place to go. (It’s separate from this blog.)