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Blue Shield of California's New Chief Medical Leader: 'People...Are Demanding Change'

Terry Gilliland talks about leading the plan's effort to bring quality care amid an environment of spiraling costs

Terry Gilliland, M.D., has begun his new role as executive vice president, Health Care Quality and Affordability, for Blue Shield of California, the company’s top medical leader.

Dr. Gilliland assumed the new role Monday, energized by the opportunities ahead. His job is to shape the non-profit health plan’s medical programs for more than 4.3 million members. Last year, Blue Shield spent almost $50 million a day on medical claims.

Terry Gilliland

He takes over from Jeff Bailet, M.D., who has been tapped to lead Blue Shield’s new, wholly-owned subsidiary company that is being stood up provide a new offering of services to physicians’ practices, as well as primary care services. Dr. Bailet hired Dr. Gilliland last year to be senior vice president and Chief Health Officer, to help drive health reforms. Even though Dr. Bailet’s role is changing, his goals align with Dr. Gilliland’s very closely: to support patients and physicians, while attaining the highest quality care at an affordable cost.

We sat down with Dr. Gilliland to talk to him about his plans for shaping health care services at Blue Shield:

What are you most excited about in your new role?

I joined Blue Shield of California because I wanted to be part of the solution to the challenges in health care. I wanted to be on the team that is enabling care that is worthy of our family and friends and sustainably affordable. That excitement continues to motivate me as I move into this new role.

The world of medicine is changing so quickly thanks to amazing advances in research and artificial intelligence, yet doctors have never been more burdened with paperwork and data entry. We need high-tech, high touch solutions to balance the way doctors and their patients engage. We have the right team in place to make that happen. That prospect is what brings me to the office every day.

Ok, so how?

We have a lot of great work already in motion. We’re strongly advocating for data sharing and collaboration across providers and payers, and we’re making good progress on that front. We’re also looking at today’s physicians and figuring out how we can better support them. We want their energy focused on caring for patients and not on burdensome administrative tasks.

I’m really looking forward to seeing how the new company, under Dr. Jeff Bailet’s leadership, can make strides in that area. We’re also looking at how we compensate physicians and determining how we can shift the focus from the number of tests and procedures completed to positive health outcomes achieved and patients’ overall health.

Speaking of overall health, we are also examining the social determinants of health and wellness and making investments to reduce the health burden in our daily lives. There’s no shortage of possibilities and I can’t wait to see where these initiatives take us.

What is the biggest challenge you face?

While most will agree that we need to transform health care, it’s a complex undertaking and requires that we approach it from many different perspectives—patients, providers, payers, etc. That creates challenges when it comes to designing solutions.

We’re working on several interesting projects, but it’s going to take more than our own employees aligning around a common mission and vision. We need to be in lock-step with the providers that are caring for our members, as well as the members themselves. Without that alignment and shared vision, our efforts will be futile.

What are the next steps for the health care model of the future?

We are actively planning and launching pilots that get us closer to our vision. Data-sharing and connectivity among providers will be key to achieving our reimagined vision of health and wellbeing. Just as we needed roads when the car was invented or phone lines with telephones, we need an infrastructure that can move data securely to decision makers to save lives, to reduce unnecessary hospital visits, to connect wearables to the doctor’s office. 

That health information infrastructure will provide foundational support to many other innovations to improve care. For example, we are pioneering real-time claims for patients and providers. When you leave a store with a purchase, you pay at the till. You know the cost. We feel that it should be that way when it comes to your health, too. You should know what you owe when you leave the doctor’s office. And you should use your time with the doctor talking about your care and making decisions with your physician paying full attention, not typing on a computer. We want to roll out our pilots with small group practices in different parts of the state to learn how they can scale. And then we will scale them. We are starting small but thinking big.

What leadership qualities will help you succeed in this role?

Patience and the ability to see the big picture. We have an urgent need to fix things. People across the country are demanding change from never-ending price increases and frustrating obstacles to care. Doctors and providers are also facing rising costs, fatigue from paperwork and frustration with bureaucracy – some of it from us.

We can’t move fast enough., but we also can’t afford to move too fast. Not because we want to go slow, but because it’s in everyone’s interest to get it right. We can’t risk one medical error or unnecessary denial of a claim. It’s just too important.

Where do you see the greatest areas of collaboration and partnership across the company (finance, innovation, etc.)?

Every, single business line in this company—from finance and innovation to contracting and claims processing—impacts the members we serve. We need collaboration and alignment from all the functions within the organization. We must deliver on the basics for our plan members today and excel at innovation for our plan members tomorrow. The future is here today, and we have more than 4 million reasons to embrace it. I’m excited and hopeful about the possibilities ahead.