Blue Shield of California chief operating officer Sandra Clarke joined host Charlotte Ross on the “Inspired in 15” podcast to discuss Blue Shield’s vision for the future of health care, misaligned pharmaceutical incentives, the promise of artificial intelligence (AI) and more.
Here, we share highlights from their conversation. And be sure to listen to the full episode: 15 Minutes On… Healthcare Transformation with Sandra Clarke of Blue Shield of California.
What is Blue Shield of California’s vision for the ideal state of health care?
Our current system is completely out of whack with the rest of our lives from both a delivery and payment perspective. We should be engaging with it proactively, but we only engage with it when we're sick. It’s also still very backward from a technology perspective — we’re one of the few industries keeping fax machines in business. Fortunately, digitization and automation can make many parts of the healthcare system more efficient and consumer friendly.
We also have misaligned incentives on the pharmaceutical side of the system. Most entities along the pharmaceutical supply chain get rewarded when the price of the drug goes up. So, when we look at our program dedicated to reimagining the healthcare system — to truly have quality care that’s sustainably affordable for everyone — we must solve this ever-escalating price system for pharmaceuticals. Everyone should be incentivized to ensure patients get the right drug, at the right time, at the right price.
How has the rise of expensive specialty drugs in recent years affected the broader healthcare landscape?
There are multiple life-changing drugs currently in process that will likely have a $2 to $3 million price tag, which pharmacy benefit managers and manufacturers set. Though these groups do take on a lot of risk when developing these drugs, these prices aren't sustainable for the healthcare system.
We are working toward paying for things at a net price basis, so everyone sees the true, final price. Equally important, we need to look at expensive drugs and evaluate the value that they're bringing to the patient from an efficacy, impact and safety perspective, and we need to start rewarding breakthrough innovation. You shouldn't be paying a lot of money for a drug that gives you only incremental improvement.
What technologies in health care would make your members' lives easier?
At Blue Shield, we have a real-time claims initiative that focuses on point-of-sale claims resolution — but to do that, we need to have one complete medical record for a patient that has all the details in an appropriate, safe space and that can be used to do the required analytics. This is not as easy to achieve as it might sound, as there’s a lot of medical record fragmentation. If you've ever moved states and don't remember when you got your vaccinations, that information isn't readily available. We're working hard in California to have one comprehensive medical record that includes all your lab results and doctor interactions, regardless of where you were.
For more, listen to Sandra Clarke’s podcast interview: 15 Minutes On… Healthcare Transformation with Sandra Clarke of Blue Shield of California.