Blue Shield of California team with industry partners California Quality Collaborative and Integrated Healthcare Association


All the data we have shows that primary care is the foundation for a high functioning health care system. It is a “common good,” as advocated by the National Academies of Science, Engineering and Medicine, and the lack of equitable access to primary care is a major contributor to the vast disparities in health outcomes that we see today. 

But primary care has been in a crisis for quite some time now. Chronic underinvestment, aggressive market consolidation, and ever-growing administrative burden have chipped away at our nation’s primary care system, resulting in a deeply alarming rate of burnout, retirement, and decline in a cornerstone of our health system.

The urgency of the primary care crisis grew exponentially during the pandemic. With many providers unable to see patients for routine care, practice revenue dried up across the country. California Health Care Foundation reported that as many as 1/3 of primary care practices in California worried they might be forced to close as a result of COVID. 

Over the past two years, Blue Shield of California has collaborated with other health plans and stakeholders to drive alignment for critical investment in primary care that helps physician practices achieve financial stability while supporting quality outcomes and advancing health equity. 


Solutions at the intersection of policy and industry 

Prior to the pandemic, Blue Shield of California was already planning initiatives to transform primary care. However, as the crisis worsened, we realized the need to immediately increase our investment in primary care practices and clinicians so they had more stability, predictability, and flexibility in the way they deliver care.

But even as a large health plan, Blue Shield of California lacked the market power to scale transformation across the state. Many practices told us that in order for our investments to make a meaningful difference in their business model, other payers had to join in the effort. Practices simply could not change the way they do business for just a fraction of their patients - real transformation requires that all of a practice’s payers intentionally align efforts to invest in and measure primary care.

Payment - Milbank event
Joe moderating panel of experts on primary care and social determinants of health. Pictured (from top left): Joe Castiglione, Blue Shield of California; Chris Koller, Milbank Memorial Fund; Laura Gottlieb, UCSF; Kameron Matthews, Cityblock Health; Rishi Manchanda, HealthBegins; James Cruz, Blue Shield of California Promise

That's why in 2020 Blue Shield of California decided to launch a new team called Industry Initiatives, a business unit dedicated to driving industry alignment and policy movement in support of health care transformation. Part of the charge given to Industry Initiatives was to find a way to achieve our mission on primary care: partner with other health plans and drive the multi-stakeholder alignment needed to scale transformation statewide.

Shruti Kothari, the founding Director of Industry Initiatives, hired me specifically to spearhead this effort. At the time, I was wrapping up my MBA program at UC Berkeley Haas School of Business, and I happened to have the perfect intersection of skills and relationships among key stakeholders to succeed in this work.

Together we built an advocacy model to drive alignment for primary care: a three-pronged approach that leverages partnership, publications, and events to bring stakeholders together to collectively scale transformation across California.


  • We funded two partner organizations - California Quality Collaborative (an initiative of Purchaser Business Group on Health) and Integrated Healthcare Association - to convene payers and provider organizations to collectively develop a "Roadmap to Advanced Primary Care in California" that outlines a path to making high-quality primary care accessible to all Californians. 
  • All of California's leading health plans participated in this effort, highlighting the shared commitment among our peers to transform our health care system, and they've committed to a 3-year process to collectively achieve goals set forth in the Roadmap.


  • We collaborated with Manatt Health to develop a white paper calling for stakeholders to work together to build a sustainable future for primary care. Manatt hosted a series of interviews with folks across our state's health care system to inform and develop this paper, underlining Industry Initiatives' collaborative approach to identifying and implementing multi-stakeholder solutions. 
  • This white paper provided key evidence and consensus that fed into our Partnerships and Events work, growing the sense of urgency and need for immediate action.


  • We partnered with Milbank Memorial Fund, a pre-eminent national authority on primary care, to co-host a series of events that tie investments in primary care to other key issues. The intent of the series was to broaden the audience interested in primary care through panel discussions that emphasized why high-functioning primary care is essential to achieving goals on issues like health equity, behavioral health, and social determinants of health. 
  • Organizations and speakers featured in the events included innovative tech platforms like Cityblock Health and Headspace Health, academic institutions like University of California San Francisco, as well as national health equity advocates like Dr. Rishi Manchanda and Dr. Stella Safo


Industry Initiatives: impact and output 

Payment - Joe moderation
Blue Shield of California team speaking on panel about primary care at Blue Cross Blue Shield Association National Summit. Pictured (from left to right): Dr. Nina Birnbaum, Angela Chen, Laura Fox, Joe Castiglione.

Our advocacy campaign has already produced incredible results. We hosted over 1,000 attendees at our events, built partnerships with more than 30 stakeholder organizations, and grew our leadership profile with key state and national entities like Covered California and the Center for Medicare and Medicaid Services. Most importantly, we’ve secured commitments from leading California organizations to collaboratively build a health care system that is worthy of our friends and family - and one that is built on a foundation of high-quality primary care.

In addition to catalyzing action, the interest in Industry Initiatives' model and work has exploded. We've been invited to speak at conferences like AHIP, Blue Cross Blue Shield Association National Summit, and Going Digital: Behavioral Health Tech. These have afforded me the opportunity to find my own voice in our work, and to truly step into my role as a champion of primary care. 

None of this would have been possible without our incredible partners - each of them played a critical role in broadening our coalition and driving collective action. 

This is, of course, not an end. It is a beginning. Much work remains to be done to transform our health care system, but the past year has proven that we can and will achieve our goals, and we will do so together.