ViVE panelists including Blue Shield of California leader Shruti Kothari share insights during a standing-room-only session.

 

Improving health and social service delivery in California is a collaborative effort. That’s why the Blue Shield of California Industry Initiatives team was proud to present on multiple panels during ViVE. ViVE is the annual digital event focused on the business of transformation in healthcare, bringing together 7,000+ C-suite executives, senior digital health leaders and buyers, health startups and investors, policymakers, the patient community, and solution providers across the nation. Together they aim to solve the industry’s most pressing and intricate challenges.

 

Addressing structural barriers to care through technology innovation

Industry initiatives leader Shruti Kothari joined a payer insights panel focused on transforming healthcare with digital tools alongside Dave Sohigian, Chief Technology Officer at Workday; Omid Toloui, Vice President of Innovation at Elevance Health & Carelon Digital Platforms; and moderator and editor of MedCity News, Arundhati Parmar. 

Among other insights and lessons learned was that when health plans leverage the power of digital transformation, they are able to create a more patient-centric and effective healthcare ecosystem. Kothari highlighted: 

  • The need for collaboration and “co-opetition” with support from technology. The healthcare industry has historically been challenged with misaligned incentives. To transform the industry, Blue Shield of California sees a future in which stakeholders would come together to align on significant initiatives. One model for future transformation is the memorandum of understanding for the California Advanced Primary Care Initiative. Signed by Blue Shield and four other large California health plans, this joint initiative by Purchaser Business Group on Health’s California Quality Collaborative and the Integrated Healthcare Association, enables these companies to, align investment and support, to strengthen the delivery of advanced primary care. The ability to collect and consolidate data into a single source of truth for plans and providers is critical to support this collaboration, which is inspired in part by Blue Shield's Primary Care Reimagined. In 2024, Blue Shield looks forward to meaningful collaboration on payment innovation.
  • High quality data is needed to fully realize the benefits of AI. While there is lots of excitement around the potential for AI to transform health care, it is important to remember that these tools will only be as good as the data behind them. Health care stakeholders need to continue to push forward on improving our ability to collect, use, and share robust, timely, and accurate data, including the ability to ingest self-identified data such as language, race, ethnicity, gender, and sexual orientation (including those of the LGBTQ+ community) so we can develop tools to better meet patients’ individual health needs.
  • Policy alignment is a key lever for industry-wide change. To make data exchange a reality, legislation can be a powerful lever that ensures industry wide alignment and compliance. In California, the California Health and Human Services’ Data Exchange Framework (DxF) is a technology agnostic framework designed to facilitate the secure and appropriate exchange of health and social services information, giving providers a clear understanding of a patient’s full health history and the information needed to provide safe, effective, whole-person care. Blue Shield of California is an advocate for this work, which also aligns to broader national efforts such as The Trusted Exchange Framework and Common Agreement (TEFCA). At a national level, TEFCA defines a universal governance, policy, and technical floor for nationwide interoperability.

To learn more about Blue Shield’s perspective, watch Kothari’s panel here (source: ViVE 2024). 

 

Data helps drive value-based care

On another panel, Joe Castiglione, Principal Program Manager for Blue Shield’s Industry Initiatives, joined ecosystem peers to talk about unlocking financial success in value-based care with data. 

This session, hosted by Health Tech for Medicaid (HT4M) and COPE Health Solutions, included Joe along with panelists Allen Miller, Principal & CEO, COPE Health Solutions; Adimika Arthur, CEO & Executive Director, HT4M; David Weathington, Vice President, Network Optimization And Provider Success, Elevance Health; and James D. Sinkoff, MBA, CPA, deputy CEO and chief financial officer, Sun River Health. The group tackled the transformative power of data analytics and the importance of unlocking its pivotal role in driving success within the realm of value-based care. 

Based on the panel discussion, Castiglione reflects on the importance of relationships in making forward progress possible. Trust is foundational for payers and providers to work together. For instance, Blue Shield recognizes that there is an opportunity for all health plans to equip providers with the right data to succeed in value-based care; at the same time, payers have an opportunity to partner more closely with providers to better understand what their data needs are to make the right decisions at the point of care. In the future this could include guidance and insights on the types of data that will flow back and forth between providers and health plans. And, agreed-upon frameworks (including the DxF) that enable this data to be timely, actionable, and digestible. 

This type of collaboration is essential to build a world in which value-based care can succeed, through seamless data exchange. The groundwork set through the combination of trust and data sharing is critical for everyone, health plans and providers alike, to be willing to take on a comfortable level of risk to do things differently on the journey towards value-based care. Only when models reflect all nuances and meet providers where they are will the healthcare landscape have the collaboration necessary to realize the benefits of value-based payments, including higher quality and lower costs. 

Learn more about Industry Initiative’s 2024 priorities here. You can also catch up on Blue Shield president and CEO Paul Markovich’s fireside chat at ViVE on the state of pharmacy care in America and the impact on payers.