Confessions of a Recovering Managed Care Executive

EDITOR’S NOTE: Ron Howrigon, who like me worked for Cigna and other big insurers, will be a regular contributor to HEALTH CARE un-covered.

- Wendell Potter

Hello, my name is Ron Howrigon and I’m a recovering managed care executive. My last day working for managed care was 20 years and 1 day ago.

I started working in managed care right out of college. I had a brand-new degree in Economics and answered a help wanted add in the Sunday paper (yes I am that old) for a Medical Economics Analyst. I imagined how proud my parents would be to see that title on a business card. I got the job and started my journey of working in, and trying to understand, the U.S. health care industry. I was working for Kaiser Permanente, and over the seven years I was there I received multiple promotions and eventually held the position of Director of Community Medical Services. 

That title sounds so friendly, doesn’t it? My actual job, though, was to negotiate against doctors and hospitals to buy health care from the people who provided it at the lowest possible price.

After Kaiser I went to work for Cigna doing the same thing. This was my first foray in publicly traded, for-profit health insurance. The next nine years were an incredible time of learning for me. I was promoted four times and transferred to three different plans. Seems I was good at making Cigna money. By the time I left Cigna I oversaw the contract negotiations (networks management) for North Carolina, South Carolina, Tennessee, Kentucky and Arkansas. I was doing very well, making serious money and getting promoted.

Everything was great, except somewhere along the way I grew a conscience.

Ron Howrigon, former Managed Care Executive.

There is a great line in the movie Gross Pointe Blank where the main character explains how he became a paid assassin. The line is; “when I took the service exam my psych profile fit a certain…moral flexibility would be the only way to describe it.” Well, as my career progressed with Cigna, I discovered much to my surprise that I didn’t have enough moral flexibility to continue down that path. I saw that insurance companies were primarily motivated by profit and their stock prices, and what it was doing to the practice of medicine in this country concerned me.

So, I left Cigna and took a job for a non-profit BCBS plan. I quickly learned that because the non-profit insurance companies must compete with their for-profit counterparts they were forced to do the same things that made me leave Cigna. This left me in a quandary. I was unhappy in my job and not at all happy with who I was doing it for.

Then something happened that changed my life, and it was a doctor of all people who made it happen. We were pregnant with our second child. We were expecting a baby boy, and I couldn’t have been more excited. 

I should probably mention that my company reduced the reimbursement for my wife’s OB about six weeks before our delivery. That’s kind of an important part of the story. 

So, when the day came, my wife had to have a C-Section. Everything turned out great and I was holding a perfect baby boy. I was thanking everyone and everything in the room. I think I even thanked the surgical tray. The doctors played it off as nothing special and all part of what they do every day. Then it happened. As the OB was leaving the OR he looked back and me and said, “You know Ron, the next time you do something that takes money out of a doctor’s pocket you remember tonight because I was the one who was here.” He then walked out of the OR.

I have to tell you, in that moment, I knew I had to make a change. I could no longer do what I was doing. I decided right then that I needed to devote my life to helping doctors rather than hurting them.

So, I took paternity leave from a great job and with an 18-month-old and a new born I started my consulting company dedicated to helping doctors get fair contracts with insurance companies. That was 20 years ago and that baby is now in college. 

Leaving the payer world was the worst financial decision I ever made. The money there is fantastic. While it was a terrible financial decision it’s best career decision I have ever made, and I would do it all over again in a heartbeat.

I like helping doctors and have gotten to know so many dedicated and incredible physicians that I feel blessed to count them as friends. I am proud of what I do and who I do it for and that, my friends, is priceless.

Yes, I am a recovering managed care executive, and I am grateful for the last 20 years!