Blue Shield of California’s President and CEO Paul Markovich took the stage at the recent J.P. Morgan Healthcare Conference for a panel with leading healthcare executives on prioritizing issues facing the industry. He opened by sharing what he believes are the two fundamental reasons for the industry’s deficiencies:

1. Health care is unaffordable, and prices continue to rise at astronomical rates.
2. The healthcare system is deeply unpopular in this country, and only becoming more so.

“We are going to hit a tipping point,” Markovich said. “The fundamental question that will be asked: Are you a part of the problem, or are you a part of the solution?”

The U.S. healthcare system can be fixed. Markovich presented to the panel key areas of focus needed to overcome intractable problems in the industry.

Bring healthcare into the digital age

Members and clinicians need a healthcare experience that operates as smoothly as other consumer digital services in their lives, such as online shopping. Blue Shield partnered with Microsoft to build a new integrated data hub, Blue Shield’s Experience Cube, bringing together authorized member, provider, and payer data into one consolidated near-real-time view. By connecting data in one place, we are making healthcare easier, simpler, and more accessible for members.

Tie pay to value

Over half of our primary care physicians will participate in a value-based care arrangement this year, and we’re seeing results. Healthcare costs dropped 10% among providers participating in the model.

Make prescription drugs accessible and affordable

The pharmacy system is a poster child for an industry that doesn’t tie pay to value. The current system involves too many entities in the process of getting a drug to a patient, with many of them positioned to make more money when members utilize higher volumes and more expensive brand-name prescription drugs.

To fix this system, Blue Shield of California’s new approach, Pharmacy Care Reimagined, goes directly to the pharmaceutical manufacturers to cut out the extra costs. The model was developed through partnerships with companies committed to reforming this system, like Mark Cuban’s Cost Plus Drug Company and Abarca Health. Pharmacy Care Reimagined builds upon the groundwork laid in recent years to address rising prescription drug costs, such as investing with other Blues plans in CivicaRx to bring affordable generic drugs to market.

Personalize a holistic patient experience

Health care needs to be high-tech, but it also needs to be high touch. Blue Shield’s Connect service takes a holistic approach to deliver comprehensive care for the highest-risk members of an employer's workforce. A designated clinical team with deep knowledge of a group's employee population and benefits programs performs outreach, develops personal care plans, and targets acute, long-term and high-risk conditions. Connect is designed for engagement and to help members live better with illness, recover from acute conditions, and develop self-management skills.

Markovich’s presentation showcased that Blue Shield of California is unafraid to challenge the status quo of health care, and we’re excited to lead the way on initiatives that are making health care work better for all of us. Read the expanded version of this article on the Blue Shield News Center.