Industry Initiatives 2021 Year-End Wrap: Alignment and Collaboration to Scale Innovation

Want more? Check out links to some of our events:

• Innovation and Collaboration to Support Birth Equity: Working to Improve Black Maternal Health
• United for a Comprehensive Vision of Health
• Scaling Health Care Innovation: A Conversation about Data Sharing, Interoperability, and HIE
• Scaling Innovation: Supporting Access and Equity in Primary Care Through New Payment Models

And links to our published white papers:

• Unlocking Race and Ethnicity Data to Promote Health Equity in California: Proposals for State Action
• Supporting the Future of Primary Care in California Through Aligned Hybrid Payment Models

Industry Initiatives Team

In 2021, I had the privilege of bringing on two new team members, Joe Castiglione and Muriel LaMois!

Joe is a dedicated and thoughtful leader, who joined as the Principal Program Manager for Industry Initiatives in March of 2021.

Joe has spearheaded our work around payment innovation and, in his short time at Blue Shield of California, has forged critical partnerships with stakeholders throughout the payment industry. Fun Fact: Joe was a referral from the Berkeley Haas Alumni Network – GO BEARS 😊

Muriel is a brilliant and insightful Program Manager, who provides support on interoperability, data sharing, social determinants of health, and other Industry Initiatives projects. Muriel joined the team in October 2021, and is already bringing a sharp and critical lens to all her work, ranging from program management to policy development.

I am thrilled to have both Joe and Muriel on the team -- I could not have asked for a better group of folks to work with, learn from, laugh with, and in the challenging moments, commiserate with. I am excited to embark on our endeavor to improve health equity and foster collaboration to drive and scale innovation!

Payment Innovation

The foundation to a healthy society is investing in primary care teams to improve people's health. Primary care is central to improving health for individuals and populations, and these trusted relationships within the health care system lead to better health outcomes.

At our panel held in December “Supporting Access and Equity in Primary Care Through Payment,” Asaf Bitton, Executive Director of Ariadne Labs said, “To achieve better health equity, we have to elevate the role and position of primary care in our policy and payment environment.” Primary care payment innovation supports access to high-quality, accessible primary care that improves health equity and outcomes.

To strengthen our priority area of primary care payment innovation, our team has worked with both the Integrated Healthcare Association (IHA) and Purchaser Business Group on Health (PBGH) to form a multi-payer collaborative dedicated to cross-payer adoption of primary care payment models. Strengthening primary care requires aligned payment models that move away from low-value services and instead invests in care teams to take care of people’s health.

 The Primary Care Pay-for-Value Hybrid Payment Model increases upfront investments in primary care and population-based reimbursement, while limiting fee-for-service payments to just the services we want more of, such as immunizations and wellness visits. Check out this linked white paper we commissioned in 2021 for more on our thoughts. 

Next year we plan to build a sustainable future for primary care in California through diverse stakeholder alignment and investment. The multi-payer collaborative will implement a roadmap for the adoption of alternative payment models for primary care in California. We will also continue our event series on primary care payment innovation to highlight the need for primary care payment reform and its role in behavioral health integration and in addressing patients’ social needs. 

Data Sharing

Data is often siloed and the sharing of it fragmented. In California, there is currently no requirement in force for organizations to share data with each other. Data sharing supports patients both at the point of care, and at the population level to give policymakers insights into population-level health needs to address social determinants of health, and support payment reform.

During our panel discussion “Scaling Health Care Innovation: A Conversation about Data Sharing, Interoperability, and HIE,” industry leaders highlighted the need for statewide health information exchange to advance individual, community, and public health.

In 2021, Industry Initiatives joined Connecting for Better Health, a multi-stakeholder coalition designed to connect health data across California.

Over the course of the year, the coalition built out communications infrastructure and engaged 250 organizations in its efforts. The coalition also engaged in education efforts aimed at policymakers and health industry stakeholders through publications and events, including fact sheets, webinars, and a policy briefing. Key partners in this effort include SEIU California, Hazel Health, Manifest MedEx, Anthem and the Riverside County Medical Association, to name a few.

These efforts culminated in July of 2021, when Governor Gavin Newsom signed into law AB 133, which requires providers and health plans to share data in real-time by 2024. The legislation also requires the development of a Data Exchange Framework that includes a data sharing agreement, as well as policies and procedures governing the exchange of health information among state health care entities and government agencies.

In the coming year, Industry Initiatives looks forward to supporting policy that better defines this mandate and making sure the state has the funding and infrastructure in place to make it a reality. We’ll also look to create other programming to further engage with stakeholders on this important work.

Social Determinants of Health

Our team is excited to include social determinants of health as an area of focus in 2022. The role of social determinants of health in predicting health outcomes is well-documented, and disparities within our population inhibit efforts to recover from the pandemic and improve the overall health of our communities.

At our event “Data-Driven Insights to Drive Social Determinants of Health Impacts”, Kiran Savage-Sangwan, Executive Director of the California Pan-Ethnic Health Network (CPEHN), opened the discussion by saying, “Today communities of color have less access to health care, poorer health outcomes, and more exposure to conditions that inhibit rather than improve health.”

Our 2021 white paper on using Health Information Exchanges to collect race and ethnicity data seeks to help leaders understand the connection between a robust data sharing ecosystem and addressing social determinants of health.

In 2022, we are collaborating with Joshua Prasad, Director for Health Equity Innovation and Health Resources and Services Administration (HRSA) Center for Innovation lead on a series of events, a cross sector approach to improving the collection, use, and sharing of demographic data that will inform the development on an action plan.

At Blue Shield of California, we have already made significant contributions to this work, by partnering with mySidewalk to develop the Neighborhood Health Dashboard, which won the DHCS Quality Innovation Award. This free and accessible tool includes over 100 community health indicators, including many social determinants of health, and helps highlight health disparities in communities throughout California.

The Year Ahead

I’m incredibly honored to be leading a team of innovators dedicated to transforming our health system for the better. As we look to foster industry alignment to drive innovation, we’re excited to continue our work in data sharing and payment innovation, while also adding the social determinants of health to our portfolio.

I invite you to stay engaged and active in our work. We are always looking for new partners and ideas as we advance our health care transformation agenda. Please reach out to IndustryInitiatives@blueshieldca.com if you’d like to get involved!

Here’s to a 2022 filled with collaboration and shared success!

Much Love,
Shruti