At a time of enormous change and uncertainty for the health care industry, the San Fernando Valley region is home to many who are embracing the challenges boldly with new ideas and fresh vision. The 10 innovators profiled in the following pages are emblematic of the important work performed by health care workers every day. They are working to improve care and lower costs — and answer the urgent need for a better health care system. For many small- to medium-sized businesses, offering health insurance to employees has become a luxury — a luxury they can’t afford. Steven J. Sell, who leads Health Net Inc.’s commercial business unit as president of both the Western Region Health Plan and Health Net of California Inc., has been working to change that. By limiting or narrowing the choice of doctors in a health insurance plan, he has helped make insurance more affordable to thousands of employers throughout California, driving down the cost of insurance by as much as 25 percent at a time when the cost of traditional insurance plans continues to skyrocket. The products — tailored or narrow plans — have proven popular. For Woodland Hills-based Health Net Inc., they accounted for a third of the Western Region’s commercial enrollment and grew by 45 percent in the latest quarter, according to company records. Sell, the child of doctors who, after graduating the Stanford Graduate School of Business, wanted to be “anything but” a doctor, is the visionary and driving force behind these new plans. What makes Health Net’s tailored plans innovative is that they are affordable, he said. “A lot of people assume that high quality has to be high cost. What we’ve been able to do is choose, through the data we have, the most effective providers that are delivering the highest quality and most efficient care. We’re able to say, ‘if you choose these providers,’ we can save you money.’” Some argue that these new models of insurance hearken back to the early days of HMOs, when the plans focused too much on efficiency and limited the choice of providers too much. Even today, there are those providers who are sure to be disgruntled with a plan that cuts them out of the loop. Health Net’s newest plans — coming to the Los Angeles area sometime next year —will take the narrow network model a step further. For employees who choose this new option, the new strategic provider partnerships will limit the provider network to just one network. Health Net has yet to choose a partner in the Los Angeles area, but its partner in Northern California is Sutter Health. “These plans are not without consequence,” said Don Crane, president and CEO of the California Association of Physician Groups, which represents large, multi-specialty medical groups and independent practice associations. “There will be winners and losers. If you are a hospital that has developed huge internal structural costs with lots of MRIs and CT Scans and Gamma Knife programs that have made you the high-cost provider, they may not include you in a tailored network because you are just too expensive.” But Crane says Sell is on the right track, nevertheless. “We know who the better doctors are and what they are doing,” he said. “Steve’s vision is to move off that and say ‘let’s only choose the best physician groups and hospitals, those that moderate cost and deliver the best quality care and only put them in our network.’ It’s a huge disruptive innovation.” Sell, previously president of MHN, Health Net’s behavioral health subsidiary and the company’s Government and Specialty Services division, said the time is right for the kind of innovation that will help save businesses money. “We spent a lot of time talking to customers to understand what was working and what wasn’t,” he said. “And what they told us over and over again is that they needed a product that was affordable and simple.” Employers, he said, simply can’t afford the kind of double-digit increases in rates that have been a staple of health insurance for the last 20 years. “We have to do something different,” he said. “We have to make it work.”
