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Transforming a Broken System

Power of Ideas - Future of Health Summit 2018
Transforming a Broken System

Health-care costs today are on a path to bankrupt our nation. Fast-rising costs are straining family budgets due to long-term stagnation of real income and prevailing fears regarding job security. Frustrated by a squeeze on costs and worried care won’t be there when they need it, Americans have unprecedented levels of anger with and distrust in the health-care system.

It’s undeniable. We have a problem. The system needs to be transformed.

As a nonprofit health plan striving to offer affordable health care worthy of our family and friends, Blue Shield of California is uniquely committed to partnering with others to transform care, reduce waste, and enhance the system for patients and providers.

Partnering to Create a New Model

Our vision of the health-care model of the future is one that brings health care into the digital age, ties provider pay to value, and creates a patient-centered approach to health. Such a transformative vision requires collaboration. Consequently, that model is taking shape through strong partnerships and a commitment to transforming a dysfunctional system. 

One example is Manifest Medex—the first state-wide health information exchange and the largest nonprofit health information network. Manifest MedEx is creating comprehensive, real-time digital health records for all Californians. This is a crucial prerequisite to transforming a fragmented health-care system by delivering essential health-care data to providers and payers on a secure, open platform.

Reducing Costs and Improving Access

Improving access to care and lowering costs is imperative. To do so requires innovation and cutting-edge, scalable technologies.

Such innovative technology comes from places like OODA Health, a group helping to transform how care is paid for. When it comes to payment, leaving the doctor’s office or hospital will be like checking out at the grocery store. Everything is settled when you walk out the door, with no surprise bills arriving later. This capability will dramatically improve the experience of patients, physicians, and hospitals, while significantly lowering the cost of care.

Another way to lower costs comes from rethinking where care is delivered, particularly for the sickest patients who need the most care. Through home-based health-care providers like Landmark Health and Blue Shield of California’s Care 1st Health Plan, in-home health services are being offered to patients in their homes, which is especially crucial in providing care for patients who are dependent on someone to take them to a doctor due to significant illness. Because care providers are available 24 hours a day, seven days a week, they can also attend to a need outside of business hours, such as at night or on weekends. This kind of care keeps patients out of the hospital and emergency room, which greatly reduces the cost of care while enhancing the patient experience.

Shaping the Conditions of Daily Life by Reimagining the Future

To reimagine the future of health, we must focus on our communities, our neighbors, and the social determinants of health. We know 80 percent of health outcomes are not tied to health care. Many factors contribute to health—from access to affordable housing to quality schools. Blue Shield of California has contributed more than $500 million to our foundation since its formation to explore the best ways to address these. Through its new strategy, the foundation is focused on efforts that:

  • Demonstrate the value of prevention by developing and testing new, sustainable approaches to maintaining health

  • Experiment with “ecosystem frameworks” as a model for addressing community health and domestic violence

  • Understand future trends and anticipate their impact on health, safety, and equity

While the health-care system may currently be broken, we are focused on ensuring all Californians have access to high-quality health care at an affordable price. We will continue leading the way by taking crucial steps to create a future of health model that works for all people and partnering with those who seek the same.