What do we need to do as an industry to transform our health care system and how can we get there?
I believe that transformation of our health care system requires us to first transform incentives and reimbursement as well as how payers and providers work together. Simply put, how we pay for and collaborate to support Californians’ health must change and that starts with engaging and activating how our members manage their health and healthcare.
The healthcare industry must be viewed from the eyes of the consumer and centered on their needs. Informed, shared decision-making, transparency and value of care as measured in terms of cost, quality and experience are critical success factors. These will ultimately benefit our members and their health. Importantly, failure to do so could lead to the unfortunate outcomes suffered by Kodak, Blockbuster and so many others that did not proactively respond to disruptive forces in their industries.
What are our short- and long-term strategies toward these efforts?
In order to develop a quality, affordable healthcare system, we need to develop and nurture technically enabled relationships with providers, and become a trusted advisor and an indispensable partner to both physician groups and hospitals. This trust-building collaboration where each entity – hospital, physician group and the health plan – performs a defined set of roles and delivers valued services will enable effective and efficient care delivery centered on our members and their families.
In the short-term, we are collaborating with providers on innovative care models to help reduce unnecessary hospitalizations, emergency room visits and bed days.
For the longer-term, together with our network providers, we are working to bring health care into the digital age. This transformation is a huge priority for Blue Shield and one we are committed to seeing to fruition.
What are your thoughts about the importance of health data sharing and information creation to support value-based care? How will the practice of data sharing and creation of information vs. simply exchanging data enhance our work and support our goals?
Putting more data in front of providers at the point of care will alone not lead to transformation of our healthcare system. With the ongoing exponential growth of scientific publications as well as patient-level data, providers today are already drowning in data. Securely and conveniently providing the right information to the right person at the right time in an actionable manner will help create a healthcare system rooted in quality and affordability. Doing so will require data collection, aggregation and transformation into information through use of decision support, data visualization, predictive and prescriptive analytic tools coupled with collaborative care model redesign.
Recently, Cal INDEX and the Inland Empire Health Information Exchange announced their merger. What is the significance of this merger and how will it impact care delivery in California?
Cal INDEX’s merger with the Inland Empire Health Information Exchange (IEHIE) creates California’s largest health information exchange, with more than 16 million patient records and 150 participating providers.
Blue Shield and Anthem initially launched Cal INDEX in 2014 with the goal of improving the quality of care and the member experience by creating one source of integrated patient information. This merger further supports that goal as it combines the scale of IEHIE with the payer commitment and data of Cal INDEX. That scale is important in helping us create longitudinal patient records for all Californians, which will serve as the foundation for collaborative population health efforts as well as more personalized, effective care at the individual level.
Creating a single source of patient clinical and claims data for a state the size of California is unprecedented and requires significant collaboration and hard work from all entities involved. We are tackling combined challenges of massive geography, large number of health plans and sheer volume of membership. That’s what makes this so different from any other effort of its kind.
We are very excited that Claudia Williams is leading the newly merged company as its CEO. Claudia is perfect for the role as she has more than 25 years of healthcare technology experience, most recently as senior advisor for Health Innovation and Technology in the White House Office of Science and Technology Policy.
Any additional thoughts on healthcare transformation and why we need it?
The question isn’t if or when healthcare organizations should change; we must change now. Rather, we should be continually asking ourselves how we can change more quickly and effectively while leveraging innovative partnerships and initiatives that will result in quality care that is sustainably affordable for all Californians.