Health Reimagined

How do you fix a broken health system? By reimagining it. That means looking at systemic issues, from burdensome paperwork to runaway drug pricing. It means weighing the determinants of health (social, genetic, behavioral, environmental, and clinical). Most of all, it means focusing on our members by building a health system that meets them where they are and prioritizes their preferences for seeking and receiving care.

  • How we’re getting there

    Every program we’re launching—whether it’s a new virtual care plan, a community outreach model, or a simpler claims process—is designed to meet these three criteria:

     

    Personal care

    Care delivered the way each member prefers: “anytime, anywhere” care

     

    Holistic health

    A wider view of care that includes genetics, social factors, and behavioral healthcare needs

     

    High-tech, high-touch support

    Tools that enable a simpler care and coverage experience for members

Health Reimagined: A healthier care ecosystem

Current state: A disjointed, cumbersome system

  • A focus on sick care:

    A reactive system in which doctors only spend an average of 7 minutes with each patient

  • Behavioral health “otherized”:

    Mental health care not integrated into health plans; limited treatment options

  • Rising drug prices:

    Runaway drug costs force patients to ration medications or even skip treatment

  • Opaque payment processes:

    Patients often don’t know what they owe at the time of service; the payment process is slow

Future state: Care that revolves around the patient

  • Whole-person anytime, anywhere care:

    A proactive, modern ecosystem in which doctors and patients view health holistically and share decision-making; care options include virtual appointments, community resources, and in-home care

  • Embedded behavioral health care:

    Behavioral health is built into plans alongside primary care; more treatment options

  • Affordable medications:

    Drugs prices controlled through price transparency tools, direct contracting, and more

  • Simpler payment processes:

    Bundled payments so providers and patients can focus on care; retail-like checkout and more

People want better care experiences and better health outcomes. Here’s how Blue Shield is building them.

  • Anytime, anywhere care

    Today, people expect more flexible care options. Blue Shield is meeting this demand with “anytime, anywhere” care, including virtual appointments, new community resources, and a “health@home” focus that enables medical, behavioral, and even urgent care at home. Our high-tech, high-touch approach will deliver a better experience for members and a better value for employers.

  • Primary Care Reimagined

    Primary care should be the cornerstone of health care, with primary care providers quarterbacking holistic care for each patient. Blue Shield is investing in provider practices and reimagining payment models so doctors can focus on patients, not paperwork, and deliver a better member experience.

  • Behavioral Health Care Reimagined

    More and more people are seeking mental health services; unfortunately, access to care hasn’t kept pace with demand. Blue Shield is working to embed behavioral health alongside primary care in our plans; we’re also increasing access to virtual appointments and online care and supporting new child and family care programs.

  • Pharmacy Care Reimagined

    With drug prices on the rise, it’s common for many Americans to delay filling prescriptions or ration medications. Blue Shield is addressing this with initiatives like the virtual pharmacy, a digitally-driven transformation of the entire prescription drug ecosystem; new access points for infusion medication; and direct contracting to manufacture low-cost generic drugs for our members.

  • Community Health Advocates

    Most of what affects our health happens outside the doctor’s office. These factors—known as social determinants of health—can include food and housing insecurity, lack of transportation or internet access, and more.

    Our Community Health Advocates help remediate these social determinants of health. Advocates are embedded in physician practices and help connect patients to local social services and support programs. For patients, these connections can make all the difference. And our studies show these interventions lead to an average of $259 PMPM saved.<sup>1</sup>

  • ShowHide Transcript

    Jose Herrera: I'm still having on my mind the idea that I'm going to make it, and God's going to help me to have my transplant. That's why I'm motivated to keep fighting.

    My name is Jose Herrera. I'm 54 years old. I have a terminal disease that he calls pulmonary fibrosis. I don't have good days anymore. I have bad days and real bad days. I met Denise at the clinic. My doctor introduced me with them. I wasn't expecting her to come to my house to the following day, and she showed up.

    Denise Oliva: There were resources that I knew that he could obtain that would be useful and make his life a lot easier. Jose's wife, Susanna, was unaware that she could receive paid family leave.

    Susanna: [foreign language].

    Denise Oliva: It helped them not deplete their savings. Our goal is to get him to obtain a lung transplant, and in order to do so, he has to be at a certain weight. So I immediately knew to link him with Project Angel Food. It's a meal delivery system that provides meals to individuals with certain health conditions.

    Jose Herrera: Since then, I've been losing 13 pounds.

    Susanna: [foreign language].

    Jose Herrera: When you visit a doctor, you're talking to a professional that is training to do his work. When you meet people like Denise, you can feel like a family, like a person you can hug.

    Denise Oliva: The better rapport that we have, the more we can coach them into being more independent and become advocates for themselves, as well.

    Jose Herrera: I'm still around. I'm still alive, so I'm not worried. I'm not going to stop here. I'm going to be fighting.

Exploring new models of care, payment, and outreach

  • value-based-pilot

    Value-based payments

    We’re exploring new payment models that let doctors and patients focus on care. In one model, we’re compensating primary care providers for longer visits, shifting the focus to more preventive care. In another program, bundled payments remove administrative hurdles, so patients with an ongoing condition (like cancer) get necessary, ongoing treatments more easily. Both create better value—and a better experience.

  • Walgreens-health-corner-pilot

    Walgreens Health Corner services

    Blue Shield and Walgreens Health are bringing care into your neighborhood. Members can walk into a participating Walgreens and get biometric screenings like A1C or BMI tests, ask follow-up questions about a diagnosis, get help understanding a medical device, and more—all without a copay. It’s care close to home.

Leveraging technology to set the stage for a better patient and provider experience

  • Real change with real-time claims

    What if paying for health care was more like other retail experiences? Blue Shield is working with Google on real-time claims, a smarter way of settling claims immediately so providers get paid more quickly and patients have more flexibility in when and how they pay.

    For providers: Blue Shield pays claims upfront

    For providers: automation means less paperwork

    For patients: consolidated, real-time view of bills

    For patients: choice in payment type and timing, including 0% payment plans and pay by text

Have questions on how Health Reimagined can help your organization?

  • 1. Based on preliminary findings from the CHA program.