by Peter Long, executive vice president of Strategy and Health Solutions
Population health is defined as the health behaviors and outcomes of a broad group of individuals. This definition comes from the Centers for Medicare and Medicaid Services, the federal agency that administers these U.S. health programs. Population health is that broad — there’s no definition of what group we’re looking to serve, or how the “health” of that group is measured. However, experts who work in this area believe that social determinants of health, nonmedical factors that influence health outcomes — like access to food, housing, and transportation — are the primary drivers.
I have a vested interest in this collaborative, solutions-based work, thanks to my “past life” as CEO of the Blue Shield of California Foundation. As head of the Foundation, I spent nine years targeting the root causes of health disparities and domestic violence to deliver solutions that would ease these issues. Today, as the head of Strategy and Health Solutions at Blue Shield, I am further driving transformation within the heart of the healthcare system.
As a member of the National Academy of Medicine Leadership Consortium, I have the honor and unique experience of taking big, future-thinking deep dives on important topics like population health, with intelligent and innovative leaders from across the healthcare industry. In our most recent white paper, “Valuing America's Health: Aligning Financing to Award Better Health and Well-Being,” we collaborated for nine months to provide new recommendations on how to address this important topic.
Many believe that population health can be improved with innovation, measuring and collaborating — often thought of as the driving principles. As the only consortium member and contributor for this paper from the health payer perspective, here’s what I took away from our conversations with experts across different pockets of the healthcare industry:
1. Systemic changes are needed.
We are not solving for a band-aid, or a point solution, but an end-to-end transformation. We need big picture, holistic and strategic solutions. I like to say that we have a “sticky floor problem” in health care. We built the floor so that people have access to care in an emergency, but too many Americans struggle to access and afford high quality care that would improve their health and well-being. So, we need to rebuild the whole foundation, starting with primary care and prevention, to drive optimal change.
2. Creative solutions are needed for providers and members/patients.
There has been low adoption of value-based care models because they are hard to implement, but that needs to change. We can't shy away from what’s hard if we want to create tangible change. We also need to address social drivers in more holistic ways, like deploying community health advocates.
3. Choose to be proactive and positive about the change you can bring.
Being pessimistic and critical without offering solutions will not help us get to where we need to go.
4. We have to be better at proactive changes within health care.
COVID-19 forced some “newer” health care concepts to latch on/take form. Virtual care took 25 years for consumers to fully adopt, but we finally did based on the urgent needs created during early COVID days. Physicians, who had been skeptical of value-based care models, experienced a steady stream of revenue during lockdowns when they could not see patients in person.
5. We have to work together to drive greater impact.
We need all corners of the healthcare system to come together to create change that’s urgently needed. And we should be able to come together for tangible, simple and aligned work that will benefit patients, members and Californians. They need and deserve it.
With that said, I am extremely proud of my Blue Shield of California colleagues for helping us achieve the following for our members, California communities and beyond:
1. Supporting health-promoting policy changes
California recently instituted a maternal health mandate for Medi-Cal members, and Blue Shield had representation on the committee driving that work. Additionally, we’ve developed our Maternal Child Health Equity program, which we’ve grown since its launch as a regional test in Fresno, Los Angeles and Sacramento.
2. Demonstrating a commitment to value-based care models/agreements
Changing the way that things have been done isn’t easy, but shouldn’t stop anyone from taking it on. Blue Shield has changed the way that agreements are structured with our providers to ones that are value-based. This means that we pay providers based on improving patient outcomes. We’ve taken on these efforts independently in the last few years, and with other members of the Integrated Healthcare Association and the Purchaser Business Group on Health via a memorandum of understanding with other health plans last year.
3. Implementing solutions that are scaled beyond our membership
As a company, we stepped forward to ensure that all Californians — and not just our 4.8 million members — gained access to COVID-19 testing and vaccinations. We did this through collaborative effort with the state, as well as collaborating with community-based organizations to reach vaccine-hesitant populations and ensure equitable distribution of testing and vaccines.
We will be more successful if we build tangible solutions as one industry. Want to get started? Learn more about the concepts above in the white paper here, as well as my interview on this topic with Laura Beerman of Health Leaders here.
Peter Long is the executive vice president of Strategy and Health Solutions at Blue Shield of California. In addition to being part of the National Academy of Medicine’s Leadership Consortium, he is an adjunct professor at University of California Los Angeles and board member of organizations like Integrated Healthcare Association and Primary Care Collaborative.