Engaging the Consumer
An accomplished sales and marketing executive in the healthcare finance field, Carla Roberts Whaley ’83 traces the beginning of her career back to an internship she completed during the fall of her senior year at Transylvania.
“Through the sociology department, I got the internship at the Lexington Clinic,” she said. “When I graduated, they called and offered me a job, and things took off from there.”
As vice president of sales for Humana-Kentucky, a title she held for roughly 12 years, Whaley was credited with helping to position Humana, headquartered in Louisville, as the largest commercial market shareholder in Kentucky. In her current role as key accounts director, Whaley oversees the Commonwealth of Kentucky account, serving approximately 250,000 insured medical members including all state employees and the school board, as well as the Kentucky Teachers’ Retirement System, serving another 20,000 members.
Her other accomplishments with Humana have included both market and corporate-level positions responsible for varying initiatives, including sales force automation, sales and agent compensation, client reporting, advisory councils, and associate training. In 2003, Whaley was appointed to spearhead development of the organization’s first company-wide customized Customer Relationship Management program.
“We didn’t really have anything we could utilize internally,” Whaley said. “This was our first attempt to get tools out in front of people and automate some basic paperwork. It was all about how we could better serve our clients.”
Finding her niche
A double major in business administration and sociology, Whaley always had an interest in healthcare. It was the liberal arts experience at Transy that allowed her to explore a variety of disciplines and find her professional niche.
“I came to Transy with the idea that I wanted to be a CPA,” she said. “I took a couple of courses in accounting, but it wasn’t as exciting to me as I’d hoped it would be. Then, I took a sociology course and I loved it. I’d never been exposed to sociology before.”
Sociology professors Richard Thompson and Dorothy Neff were great influences as Whaley looked to her future career.
“Dr. Neff suggested the double major,” she said. “She pointed out that this was the path I was on with the courses I was taking. I loved sociology, but I didn’t want to be a social worker. She knew of my interest in healthcare, and she was instrumental in setting up the internship with the Lexington Clinic.”
Shortly after Whaley was hired by the Clinic, it went into a joint venture with an HMO. That company was acquired by Humana in 1988 and, except for a brief sabbatical when her youngest daughter was born, Whaley has been there ever since, primarily in sales and marketing.
“On June 3, 1996, I turned 35, found out that I was pregnant, and was promoted to head of sales in Kentucky—all in one day,” she said. “I had my third daughter right before I turned 40, and I was managing a staff of about 75. There were days when I would walk into the office on three hours of sleep. I felt that my health was at risk, and I needed to do something a little less demanding.”
Whaley was only away from her job for 11 months, however. Even though juggling demands on her time was still a challenge, she returned to her former position with the support of her family, and it’s a career she loves.
“What I do is very exciting,” she said. “The minute you think you’re getting bored, something in the industry changes and there’s new information to learn and share.”
The healthcare system in the United States is complex and interwoven, Whaley said, and those involved with it need to educate themselves about a variety of subjects. She recently attended a conference, for instance, to learn more about the American Recovery and Reinvestment Act (the Stimulus Package).
“More emphasis is being put on health information technology,” she said. “The idea is to build an infrastructure that will allow medical records to be transmitted electronically. While I’m not intimately involved in that, I know it’s something we need to promote, so I wanted to learn what’s available and what the incentives are for hospitals and physicians to get on-line.”
She sees this as an exciting development. “When you think about how many times you have to fill out your medical history,” she said, “from one doctor’s office to the next, it’s constant duplication. A doctor orders an X-ray, and maybe you just had that same X-ray a year ago at a different office, but it’s inaccessible. There’s so much inefficiency, and that means there’s so much opportunity.”
Healthcare reform, Whaley said, is not simple. She has seen many changes in the field during her career and anticipates more on the horizon, including a move away from preventative care toward genuine wellness.
“When I first got into the business, we were primarily promoting the HMO concept,” she said. “This was a plan with a restricted network of physicians. You could see your doctor for a co-pay of $5-10; you could get your prescription filled for $3.”
Whaley said she believes these rich benefits created a culture of entitlement, wherein people really didn’t understand the cost or value of healthcare. “If you’re paying $5 to see your doctor,” she said, “you’re not really looking at or understanding the full cost.”
In the early ’90s, the healthcare industry entered an era that saw members pushing back on HMOs because they were too restrictive. “We started loosening the gates again in terms of medical management and bigger networks,” she said. “But there’s a price tag associated with that.”
What Whaley sees as the future of healthcare is a sustainable system based on consumer-driven plans, with a dramatic change in the delivery system.
“Engaging people in a healthcare plan where they have some out-of-pocket cost is going to cause them to be better consumers,” she said. “If your doctor says you need to get an MRI, you can then shop around and see where’s the most efficient place to get that done. A more informed, involved consumer can make better decisions.”
This also means, Whaley said, that instead of relying on the family doctor, consumers will begin to look at other avenues, like small clinics or physicians who make home visits. “We’re even seeing eVisits now,” she said, “where you go on-line, speak to a physician, and get a prescription electronically.”
Emphasis on wellness
Hand-in-hand with this trend toward consumer-driven healthcare is the push toward wellness, Whaley said.
“Part of the reason healthcare costs are what they are is because we don’t take care of ourselves as a society,” she said. “More and more we’re going to see employers offering wellness incentives.” Incentives like the walking program recently introduced by one of Whaley’s clients, the Commonwealth of Kentucky. Participants in the program wear pedometers that track their daily steps. This information is uploaded to a Web site where steps are converted to points. At the end of the year, the points can be cashed into gift cards for area businesses.
“The near future is going to be based on incentives to get healthy and stay healthy,” she said, “because ultimately, that’s what’s going to impact your long-term healthcare costs—individuals taking personal responsibility for their health.”
While she knows some may not agree, Whaley sees this evolution from HMOs to consumer-driven healthcare as a positive change. “When you look at the big picture,” she said, “if we don’t make this evolution, healthcare costs will not be sustainable. We can’t keep going in the direction we are going.”
Whaley predicts other coming changes in the healthcare industry that include, along with the exciting possibility of on-line health records, increased transparency.
“If you are asked to take on more responsibility, then you need to have more information made available to you,” she said. “You can get a consumer report on just about anything you want to purchase. I think we’re going to see more of that in healthcare, as well.”
The connections of life
This idea of interconnection, how one thing feeds into another, is central not only to Whaley’s work, but also how she views her life. She and her husband, Anthony, live on a 300-acre beef cattle farm and raise three daughters, Olivia, 12, Leslie, 9, and Margaret Jo, 7. Her busy career and personal life don’t leave much time for hobbies, but Whaley feels it’s important to give back to the community. She’s served as a board member and president of the Greater Louisville Association of Health Underwriters and has participated in other nonprofit boards such as the Louisville Chapter of the American Red Cross, Christian Care Communities, and Hospital Hospitality House.
“If everyone volunteered in his or her community, we wouldn’t be in the crisis we’re in when it comes to social services,” she said.
Whaley received a distinguished achievement award from Transylvania in 2008, in acknowledgment of her uncommon commitment to excellence in career and community service. She has frequently achieved President’s Club status at Humana, which annually recognizes top sales performers, and was nominated for the 2006 Woman of Achievement award, sponsored by the River City Business and Professional Women organization. She is also a Leadership Louisville Bingham Fellow, class of 2002.
As for the future, Whaley said the jobs she’s had for the past 13 or 14 years represent the reaching of an ultimate goal.
“To be the head of sales, in charge of large accounts,” she said, “that was what I aspired to do. I know I’m going to stay in the healthcare industry, but I’m not sure what path that’s going to take. I do know that I want to continue to do something that’s going to be impactful and bring about positive changes in healthcare. I want to make people’s lives better.”