Blue Shield of California began its aggressive transformation toward value-based care years ago. Yet when CEO Paul Markovich hired me last year as the company’s first chief innovation officer, my mission was clear: go bigger, bolder, faster.
The fast-growing field of non-traditional competitors brings with it a new urgency for providers, payers, and investors. Giants like Google, Amazon, and Walmart Inc. along with scores of tiny tech startups challenge us to improve every step of the patient’s journey – prevention, examinations, facilities, diagnosis, billing, processing, payment, and more.
With 4 million members and 65,000 California physicians in our network, we take that challenge very seriously. We strive to deliver greater value through a CEO-led innovation effort with full support of our board and senior leadership team. Through partnerships, venture investments, private equity, and in-house startups, we’re blazing trails to better patient care that others will follow. Let me offer a few examples.
Claims processing today is a very labor-intensive, manual system that takes weeks or months. We see a lot of waste and administrative cost that, frankly, shouldn’t be in the system. So, we began a pilot program with OODA Health and Dignity Health with a goal of providing real-time claims processing to all our members and providers by 2023.
Blue Shield of California also has begun a few pilot programs to pay for genetic testing that will help our members identify the treatment plan most likely to help them quickly.
Where Does It Hurt?
We’re also giving members new venue choices that improve outcomes and lowers costs. We’re experimenting with convenient retail healthcare clinics, virtual home-based care, and home monitoring technologies that can keep a small problem from becoming a life-threatening crisis.
We invest in companies like Manifest MedEx to help provide real-time access to patient health records because we believe that data belongs to our members, not EHR/EMR (electronic health record/electronic medical record) companies or hospitals. That’s helping doctors understand what’s happening with patients before they even show up for care.
Although Blue Shield operates as a not-for-profit, we founded and spun-off Altais as a for-profit startup and expect other investors to join in. Altais helps clinicians connect with next-generation tools, technologies, and services that enhance their ability to serve patients better.
Longer Patient Visits
In another pilot program with Notable, we’ve given Apple watches to doctors and nurses to record patient interactions and pre-populate medical records through natural voice recognition. This lets them spend more time with patients, and less time with paperwork. Instead of reimbursing doctors for a 15-minute patient visit, for example, we may reimburse for 60-90-minute sessions.
This allows for more personal care. Within Blue Shield, we discuss high-tech and high-touch models that allow patients more thoughtful care and doctors more automized advancements to help speed up administrative work and allow for more 1:1 time between both parties. This pilot program that allows for elongated patient visits is a great example of that.
“Reinventing healthcare” is more than a vague concept to us. It’s what our members need and want. It’s good business. And it means we’ll proudly remain among the disruptors, not the disrupted.
Jeff Semenchuk, the senior vice president and chief innovation officer of Blue Shield of California, will be speaking at the BDO Healthcare symposium on Jan. 13 during the JP Morgan Healthcare Conference in San Francisco.
