Dr. Jeremy Wigginton started his career caring for patients in rural Louisiana and Mississippi. He loved making a difference in people’s health, but he wanted to do more.
So Dr. Wigginton left full-time practice for a job in the health insurance industry.
“It's about being able to make an impact on a larger scale,” said Dr. Wigginton, who’s the Chief Medical Officer at Capital Blue Cross. “I have a passion for helping people find high quality and affordable healthcare. When you’re a physician in practice, you can only impact those people who you see in clinic. By moving to the insurance industry, I can have a potential impact on hundreds of thousands of people.”
Dr. Wigginton is one of many healthcare professionals at Capital Blue Cross – from doctors to nurses to pharmacists – who use their training to help members access affordable, quality care.
How our medical professionals advocate for your health
Capital’s medical professionals make an impact in many ways, including:
Supporting the best treatment options: Capital’s medical professionals work with your doctor to help ensure the care you receive from your own doctor is safe, effective, and aligned with your unique health needs. By working together, we can review treatment plans with your healthcare provider to prioritize your well-being and help avoid unnecessary or potentially harmful procedures.
Promoting high-quality care: Our professionals develop and implement programs that seek to help support your healthcare provider to provide safe and effective care.
Keeping medications affordable: Our pharmacists help determine which medications prescribed by your doctor are the most affordable, such as generics versus brand-name drugs, and help avoid wasteful spending on drugs.
Helping make care more affordable: By having medical professionals on staff, Capital strives to make sure you receive high-quality care at a fair cost. By thoughtfully reviewing care plans and working with providers, we can better manage healthcare costs and keep your out-of-pocket costs more predictable and manageable.
Encouraging healthy habits that last: Our health coaches, care managers, and dietitians provide personalized support to help you make meaningful lifestyle changes—like eating better, staying active, and managing chronic conditions. These small steps can lead to a better quality of life today and help prevent more serious health issues down the road.
What medical professionals do at insurance companies
While Capital’s team of medical professionals doesn’t provide hands-on care, we are working to address how medically necessary treatments, procedures, and medications are covered—focusing on both quality and affordability. These experienced clinicians also help design programs and services that help members proactively improve their health and remove barriers to care, making it easier for members to get the help they need.
A key part of our medical professionals’ role is understanding which treatments are the most effective and safest, based upon clinical research and best practices. When care is unnecessary or ineffective, it can cost you valuable time and money.
That’s why we’re committed to help ensure you are receiving care that truly makes a difference. Capital’s current staff includes 13 doctors, 12 pharmacists, and nearly 150 nurses who are licensed and credentialed by the state in which they reside.
Meet some of them below:
Patricia Higgins, MSN, Senior Vice President of Healthcare Delivery
Patricia brings extensive industry knowledge – including experience as a registered nurse – to her role. She leads provider relations, clinical programming, and pharmacy functions – key areas that help Capital deliver on its commitment to offering our members access to quality, affordable healthcare.
“My background as a registered nurse gives me a deeper understanding of how Capital can develop payment models and partner with providers to enable access to affordable, high-quality care,” she said. “That focus guides every decision we make.”
Jeremy Wigginton, M.D., Chief Medical Officer
Dr. Wigginton leads all clinical and medical policy areas at Capital. Before coming to Pennsylvania, he practiced medicine in rural communities in Mississippi and Louisiana and taught medical students.
“At the end of the day, we’re a healthcare company,” he said. “We need the expertise to make decisions and help members have a closer relationship with their primary care physicians. Healthcare can be disjointed; we help glue it all together to make sure our members have the right types of providers in our network providing the highest quality services at the right price.”
Mark Jacobson, D.O., Senior Medical Director of Client Analytics
Dr. Jacobson’s primary role is working with employers to develop tailored health and wellness programs that may improve the health of their workforce. Dr. Jacobson’s expertise is particularly focused on managing populations with chronic conditions and maximizing the impact of health and wellness programs within organizations.
“We focus on keeping people in good health and ensuring the ‘rights’ of population health – which means getting the ‘right’ people the ‘right’ service at the ‘right’ time and the ‘right’ place,” he said. “That’s where our expertise comes into play. You need people who have clinical backgrounds to help you make those decisions.”
Gary Petruzzelli, PharmD, Vice President of Pharmacy Strategy & Services
Gary has spent nearly two decades in the industry as a pharmacist, clinical programs leader, and pharmacy leadership roles. He leads a team of pharmacists that, among other things, helps determine what medications Capital can cover with a focus on safety, affordability, and effectiveness.
“What I like about Capital is we’re very member focused. The member always comes first,” he said. “We help keep medicine affordable, because if a drug costs too much, a member isn’t going to be able to take it – and it does them no good. We work hard to balance what is clinically effective and what is cost effective.”