Published August 23, 2010

WBUR’s Martha Bebinger, fresh off a one-year fellowship at Harvard’s Nieman Foundation, is back in the newsroom. Martha has years of experience covering health care and hospitals in Massachusetts. –AP

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Can you run an insurance company and the chamber of commerce without a conflict of interest?

Paul Guzzi finds himself in a dual role as president and CEO of the Greater Boston Chamber of Commerce and chairman of the board at Blue Cross Blue Shield of Massachusetts — the state’s largest health insurer.

Some hospitals and physicians are saying they aren’t sure, in some meetings with Guzzi, whether he represents the interests of employers (hospitals) or that of the insurer (Blue Cross).

Paul Guzzi

Blue Cross is pressing hospitals to accept a new way to charge patients — changing the “procedure now, bill later” paradigm. The insurer says providers will spend less if doctors have to manage a budget for their patients.

Physicians and hospitals would receive bonus payments if they increase preventive care such as cancer screenings or asthma check-ups.  But providers could also lose money if they have to spend more than expected on patients.

Guzzi says he’s very sensitive to the possibility that what is best for hospitals and what is best for Blue Cross may be in conflict.

“There have been no conflicts to date, and if there were, I would recuse myself in either role,” he said.

Guzzi was elected chairman of the board for Blue Cross in March.

He says he is clear in dealing with hospitals, some of which are the state’s largest employers, that “my primary responsibility is to be CEO of the Chamber of Commerce. I have a non-executive role at Blue Cross and Blue Shield.”

Discussion about Paul Guzzi’s dual roles illustrates a larger dilemma for Massachusetts as it works to control rising health care costs: Can the state reign in health care spending without disrupting the jobs or research that makes Boston a health care mecca? What do you think?