Healthcare | Modernizing Care with Blue Shield of California

Speaker 1 (Hank)

Thank you, everyone, for coming today. We have a really exciting session today. I think a few years in the making in terms of some of the great work that we've been doing with Blue Shield of California. So, she's really excited. And first off, I wanted to thank the Blue Shield organization as well as Salesforce. I think it's been quite a journey as well as exciting to see some of the great things that Blue Shield is doing and for KPMG to be able to be a part of it, I think has been a blessing and we've been excited to kind of be along the journey and support them and some of the great things we are doing.

And today the focus for the session is really modernizing care in today's complex health care ecosystem and in today's orientation, there's a lot of changes that have happened increase in regulations and lot of changes in experiences. So, we wanted to give you all kind of a chance to hear about their story. So, I think the first thing we'll start out with is just talk a little bit to our agenda and then we'll also introduce some of the folks that you see on the stage here.

Speaker 2 (Saurabh)

Right, thanks Hank. So, we have a pretty action-packed agenda today and we're going to provide some introductions and give you a background about Blue Shield of California and who they are as an organization serving members in California. What were some of the goals and aspirations of the team when we started down this journey a couple of years back and then what was a true business opportunity to serve the members here?

What was the journey? What was the value proposition, and then what were some of the lessons learned? So, before we go down, let me call out some of the folks out here and introduce themselves. Bill, you want to go first?

Speaker 3 (Bill)

Yeah, yeah. Bill Giard, the vice president of enterprise architecture, and health innovation at Blue Shield. So, I lead our overall technical strategy. I've been at Blue Shield two and a half years prior to that, I was 25 years in high tech. And it's been really exciting to see Blue Shield of California and the health care industry just rapidly adopt and evolve new technologies and deployment and things like we're doing here in care management.

Speaker 4 (Bryce)

So, I'm Bryce Williams. I lead our digital transformation initiatives, Blue Shield of California, which is shorthand for how you deploy more digital features out into the world, how you break up manual processes and automate them, and then how you make them so incredible that people actually want to adopt them. And so, whether they're members or patients or clinicians or providers, they say, I want this, I want a better healthcare experience.

Speaker 5 (Tracy)

And hi, I'm Tracy Alvarez and I have the best job ever because I'm the vice president of medical care solutions. And so, we have all of the clinical operations, including care management for Blue Shield.

Speaker 1 (Hank)

Thanks Tracy, And Hank Yang so I help lead our healthcare life science Salesforce capability for KPMG. So, it's a really exciting content that we’ll get into here.

Speaker 2 (Saurabh)

And I'm Saurabh Goyal and I'm a managing director in our healthcare practice and I've had the privilege to work with Blue Shield for the last several years. So, Bryce, let's start with you. Would love for you to provide this group an overview about Blue Shield as an organization and what they really stand for. And, you know, in the state of California serving its members.

Speaker 4 (Bryce)

Yes. So, our slides seem to have gone a wall the wallpaper is gone, but that's okay. So, first there's the who we are. The who we are is fairly straightforward or California based health plan, which is approximately just under 5 million members. We have around 7000 employees, plus or minus. That's that's what we are. But more important to me is, is who we are.

And that'll lead into why we did what we did. And, and who we are is pretty straightforward. We are committed to transforming health care with all the stakeholders and partners within the health care ecosystem to essentially get to a place where the health care system is delivering care worthy of our family and friends at an affordable price. And that's a pretty audacious statement when you say care our family and friends, because we all know what that feels like when we get it correct.

When you're in a physician's office, when you have health care insurance, you know what that feels like. And you also know what it doesn't feel like when you don't get it. And unfortunately, I think in the health care system, some of us get care worthy of our friends and many of us tolerate care that’s not worthy of our family and friends. And so, when we start to think about this, we have a guiding north star some several principles that are not on that screen.

But that's okay. And I'm not going to list all of them for you actually kind of says like you have to do several things really, really well at once. It's one of those things where all things have to be true, or none can be true. And so, I’ll just list a couple of them for you. You have to deliver high quality experiences.

It doesn't matter whether it's a member or a patient, a provider or anything like that. The experience actually has to be positive too. You actually have to look at making it affordable. Health care costs continue to increase in this country. Affordability is a kitchen table issue for pretty much all Americans, and so you have to do both experience and affordability at the same time.

And finally, germane to the conversation we’re about to have is you have to be digital first. So, you have to work with partners who have the mindset that digital first solutions are what you lead with and digital first solutions actually drive outcomes. And so, a lot of times you hear that health care is a laggard in digital adoption. That may be true and that maybe not, but I would argue that where health care really starts to lag is digital technology investments that actually improve the process. And so, at Blue Shield of California, when we talk about care worthy of my family and friends, it's being digital first to actually improve the lives of those we serve.

Speaker 1 (Hank)

Thank you, Bryce. And I think from there, I think what's been really important as a part of I think for Blue Shield has really gone next is taking a look at the direction. So, Tracy one of the questions we have for you was in terms of the way you look at medical care solutions in the health care environment today, how has some of your thinking changed in terms of really modernizing and kind of figuring out where you all are going next?

Speaker 5 (Tracy)

Yeah. Well, Bryce mentioned it, you know, a minute ago with our mission. And our mission is to serve Californians with high quality care and affordable price. So, someone who is involved in clinical operations, that's obviously really near and dear to our heart. So, we also, as we think about that mission, take it into okay, how are we going to actually re-imagine health care?

Health care needs to be much more holistic. It's not just about going to the medical doctor anymore. It's all about making sure that behavioral health needs are met, making sure that social determinants of health and social barriers are taken out of the way for access to care. So those were some of the things that we were thinking of as we as we started on this venture.

And then the third, we also wanted to make sure that our team members so in a clinical operation department, we have clinicians, we have non clinicians, we have support workers, we have community outreach workers. How do we make sure that all of those team members are working together and more importantly, working at the top of their scope of licensure to make sure that we can help that member on their health care journey.

Those are the things that we were thinking about when we started off on this venture.

Speaker 1 (Hank)

Thank you, Tracy.

And, Bill, in terms of the technology and really how you thought about solutioning and really achieving some of the things that Tracy is talking about. Can you tell us a little bit about the journey for you all?

Speaker 3 (Bill)

Yeah. You know, first, you know, I think Tracy and KPMG and the team did a pretty extensive duration and assessment of around what does it mean to reimagine care management and for Blue Shield that really meant putting the member first really at the center of the clinical decisions collaboration and increasing collaboration with the providers and the physicians and the really extended care team.

What that meant technically is that we needed to really provide quick access to information, real time information access. We needed a platform that could combine systems that, you know, lived in many different places, whether that's clinical history, medication, prescription lists, chronic conditions, immunizations, health risk assessments. And so, all of those are really solutions that in the health care industry, we get from multiple sources.

And so real time information exchange was really very evident and clear as part of our platform strategy and we're moving as a health care and the insurance industry as a whole, to really real time information, decision making. We also needed to be able to apply technology to help Tracy's team be more efficient. We have an intrinsic, you know, core desire and North Star, as Bryce talked about with really serving more members and giving them the care that they need when they need it.

So that means that we have to scale, you know, if we can personally touch every one of our members through technology, through our people, make it personalized, that was really part of our core platform strategy. So, integrating multiple systems, making the teams more efficient, and really bringing technology to bear to really solve the most complex set of technology decisions.

And it was highly regulated. And so, you know, there's a really broad swath of of technical decisions we had to make architecturally to really drive us to make sure we can, you know, really meet the needs of future.

Speaker 1 (Hank)

Thanks Bill. Bryce, I think from our transformation perspective, you know, I think with with Tracy's vision kind of how she words things as well as really thought through some of the technology transformation leader, what are some of the key things that you were focused on to really help drive things forward?

Speaker 4 (Bryce)

Yeah, I think for me from a digital transformation lens, and you know, when I show up with Bill and Tracy, I say, here's the digital health guy. And then Bill laughs and says, Well, maybe you're kind of a healthy digital novice guy. But when we start to think about digital transformation, I always think about three things that me and my team need to do in partnership with my technology colleague and my clinical colleague to make things worse, worth, not worse.

It worth that. And I call them the three A's. And one of those is thinking about what digital features are we actually making available. But it's a numerical count, like how many more digital features do we have to put out in the in the world so that people can use them? And then once we got them out there, how do we automate those processes? So, they work really seamless, really quick with virtually no errors to them. And finally, where the rubber hits the road is, do we get adoption? Because that's what you do all this for. You don't do it just for cool tools and cool toys and like saying you automated things, you do it, so people vote with their feet, whether they be clinicians or members or patients, and they say, yeah, you nailed it.

And so, I think from a digital transformation lens, if we could walk out of this project with those three things, I think we did well.

Speaker 1 (Hank)

Thanks, Bryce. I think really well said and I think all these perspectives really helped think around out some of the thinking that you were hovering around this. I think we have something really neat. That's next. And Tracy will give you a minute to kind of introduce what we're about to show everybody in terms of the video.

Speaker 5 (Tracy)

Great. So, Care Connect is the the platform that we selected and that we worked on for about nine months before we went live in January. And so, we have a video that's going to show you a little bit about what it is and how our team members use it.

Speaker 1 (Hank)

Thanks, Tracy.

VIDEO PLAYED

Speaker 2 (Saurabh)

Thanks, Tracy for sharing that. So, let’s move on to the journey which we’ve been referencing for the last few minutes. It was, it’s been a really long three year long journey so far. So can you talk to us a little about how your team and Blue Shield of California really pivoted from a traditional care management approach to a really member centric approach.

Speaker 5 (Tracy)

Sure. I like to explain it this way. The continuum of care is really shifting and traditionally it’s been a lot of utilization management kind of a mother may I can I do this type of a service. And as we were talking about the value prop, we needed to flip that on its head and say you know, let’s really think about the member first and what does that member need and how do we make sure that we can work with that member to keep them from becoming and rising in that in that high-risk area. How can we help to keep them healthier so that they don’t need some of that complex care later on. And even so, also, making sure that again we’re kind of removing some of those social barriers to health and actually putting a health equity lens onto that as well.

So those are a lot of things to think about as we’re starting out on this journey, and we also needed to think about how we actually engaged with our members. And with any typical health planner or payer, you’re going to have a finite number of people that can actually outreach to that member. And so again we needed to think about it a little bit differently and how can we work with others who actually also have contact with their members so our providers and providers at our provider offices, people who work in what we call community providers, community resource centers. All of those avenues have the ability to then now, take a look at what we’re doing as well and have that one picture of the member. So outside of Blue Shield of California but having that connectedness. Those are some of the things that we wanted to bring in together into a platform to make sure that we had that end-to-end solution.

Speaker 2 (Saurabh)

And Tracy, this also needed for you to develop and demonstrate a very strong value proposition and build consensus within Blue Shield and with some of the leaders. So could you also talk to us about the process a little bit and what advice you have for some of the leaders in this room as they embark on similar transformations.

Speaker 5 (Tracy)

So, first of all, it was really interesting because we worked with KPMG for probably almost a year just in level setting on what we wanted to do, what were those opportunities and then how do we share them internally with our key stakeholders so that they understand what we're also trying to do. So, in a in health payer, you know, surprise, not everyone is involved in the clinical piece of the work.

Right. And so really helping others understand that what we wanted to do in care management wasn't just about one area helping someone, but it can all and make it all inclusive and making sure that that all of our our folks in our organization knew what we were up to, and we were on board on that together. So, we spent some time in looking at what that would look like, doing some journey, map mapping, etc. And when we were ready, then we got in some of our key stakeholders like Bill and Bryce, so that we could actually then really encompass all of what we wanted to do and move it from kind of being theoretical to actually now having an architecture and a platform and a digital transformation lens all on top of that so that we can kind wrap that picture up.

Speaker 2 (Saurabh)

Absolutely. Yeah, it was definitely pretty exciting to work on this engagement with your team and working with the several leaders across Blue Shield. Bill, you know, with any transformation project like this, there is almost always a technology component to transform and uplift care management in this case. So could you talk to us a little bit about how you went about selecting a strategic vendor partner to uplift the platform.

Speaker 3 (Bill)

Yeah, I think one of the premises that we started with is that we needed to make sure we had a platform technology that could continue to grow and evolve with the needs of the business. It was fantastic to actually start that process with a very well-defined set of business requirements. So that's not always the case so I think that with the help of KPMG and and Tracy and the rest of the team, we entered that phase with very clear ideas and goals around how we were going to transform, you know, the care that we give our members. But then we, quite frankly, did the traditional RFP. We looked at the best-in-class care management vendors in the industry. We met with industry analysts, we shortlisted the set of vendors and came up with a top select few and then put them through the ringer, so to speak. We made them show us that they could meet the highly regulated requirements, especially in California, for caring for our dual special needs plan members, which is about the highest bar you can get for delivering care and such that we could extend that beyond to every line of business, which we are doing today.

But so really good requirements, making sure that you’re very detailed and your technical strategy, which is a platform strategy for Blue Shield, which means we're moving away from best in class one off solutions to best in class platform capability, which allows us to do more than we could have done before and then show us, you know, as they say, you know, you have to show us and prove that there was and we went through not only the RFP, but a pilot phase that says here are some very specific, highly regulated use cases that Salesforce had to prove that they could deliver.

And then we got to work after that. So, it was really, you know, making sure we were a very detailed and thorough both in the business requirements and our technical strategy with clear line of sight, the ability to execute. And quite frankly, this program should have taken probably two years in technical development. And with Salesforce help, we did it in less than nine months by the time we were in full swing.

Speaker 2 (Saurabh)

And Bill, could you also emphasize a little bit about about the backend infrastructure around enabling pieces you had already put in place?

Speaker 3 (Bill)

Yeah, I mentioned earlier that, you know, one of the key requirements is real time information. And, you know, certainly in healthcare, one of our top challenges is real time, you know, clinical information sharing, whether that's from our providers, whether that's, you know, various levels of understanding for their medication and prescriptions to chronic conditions and immunizations. And the list goes on.

We had to tier and make sure that, you know, for our 4.8 million members, we could get real time access to that information and then pull it in and be able to persist it such that the clinical team could understand what was the, you know, full 360 view of the member while we defined their care plan. And then how did we evolve it over time?

And so that means we had to get out of the data movement game, that there's no way that Tracy's team could be as productive as they wanted to be if we were waiting on data to be delivered into the Salesforce platform. And so real time information our cloud our data strategy is using something that we call the experience queue, which is different than Salesforce’s experience cloud, which we also use for our members.

That essentially is a very large data environment that really, we pull information from both Blue Shield, from our providers, from our members for other sources of information, whether it's admission and discharge data, utilization management data, clinical data, and then Salesforce accesses that in real time. So, we were early precursors to what's now the data cloud. Last year, we called it Genie. You know, that's the strategy we’re moving forward. We were very deliberate with respect to the need to be able to continue to leverage our data investment in our healthcare ecosystem. So, it connects our health cloud, right, which is what care connect is built on connects to our experience cube, which is in another cloud environment, and it does it in real time.

Speaker 2 (Saurabh)

Thanks, Bill. Sounds like it's absolutely rigorous journey over the last couple of years.

Speaker 1 (Hank)

So, we're going to get a little bit into, I think, some of the key successes and value that I think Blue Shield has achieved. I wanted to take a moment, though, I think, to thank all the teams from Salesforce services, from KPMG, as well as the rest of some of the Blue Shield team that's also here. I think it was definitely a collaborative and team effort to really get, I think, to the successes that you see on the screen.

So, with that, I think Tracy would love for you to share a little bit about some of the successes that you've seen as the platform has gone live some time’s now past in terms of what you've seen, what's some of the value that you've seen come out of the work?

Speaker 5 (Tracy)

So, when we were building this this platform and the work on this system, we were marching to a January 1st date, and we were marching to that date because we knew we were going to be transitioning several thousand of what we call our decent members. So, members who both have Medicare and Medicaid and there are very certain rigorous requirements that must be done.

And we were not stopping. We had to we had to be done on January 1st. And we didn't have a system to back that up, to go back to. So, it was risky. And you know, with the with the strong partnership that we had and a lot of a lot of late nights, we we hit that target. And, you know, so we were able to put that membership onto our platform, do the engagement, do the care planning, do all of the things that we needed to do within the first 90 days of going live.

We also put on all of our other lines of business. So, anyone who is is a part of our care management team and from a member perspective is now into the care connect system. What I really like to tell people about in any you look at the number of of systems that we have in place, it's 13.

You're like, okay, you know, what does that really mean? But if you're a clinician or if you're a community support coordinator, you now have access to 13 different systems that are there in this bill set real timers near to real time that can take place. So, you don't have to spend time logging into several different systems, getting the information so that you can talk to a member. You can prepare your, for that discussion with your member by just going to different tabs and seeing all of their medications, seeing what we're what other feeds we get in from from sources of authorization, any type of behavioral health information that we have.

So that when you do have that conversation with the member, you're having a much more holistic conversation. Part of our health reimagined, which we talked about in initially. So, the quote that's on the right-hand side is from actually from one of our team members using the system. And I will be honest, and change is hard. And so, we went live on January 1st, and we have our finishing and finalizing a lot of our processes.

But our team members, once they got used to this system actually found it so much more easier to use and intuitive in the work that they were doing to try and help our members. And that was really key. That was important to us, as I said in the beginning, making sure that that we have folks working at the top of their scope of licensure.

And then finally, we also have been able to have access to the system by some of our enhanced care providers or our community providers. So, for our specific Medicare population. And so, we've actually have more than 800 community providers and users on the system all being able to look at the same information and updating information that everyone will also have the ability to see.

And again, that's really key from having that end-to-end solution that we were looking for.

Speaker 1 (Hank)

Thank you, Tracy. And Bryce, I know in the beginning you talked a little bit about Blue Shield as an organization where you all are headed. How has some of the successes and some of the results in terms of what you've seen kind of come out of this effort, really align with health care reimagined and some of the core initiatives that you all have.

Speaker 4 (Bryce)

Yeah. So, thanks Hank, I mean for me, so I live in California today. I used to live in Texas for several years and there was a phrase in Texas I always loved it says, you don't have to, you get to. And I think if there's one thing, we kind of prove is when you have a get-to mentality into a project, you can to prove yourself and you can prove to the industry that you can do things that you might not have thought you could do from the start.

So, can you say, did we select a futureproof platform that is going to take us into the future ship in future with our partnership with Salesforce? Yes. Were we able to simultaneously do it in nine months instead of 18 to 24 months? Yes, we were. Did we start with the highest risk, highest need patients instead of doing the easy patients? Absolutely. Yes, we did. Were they also the most highly regulated population we could choose? Yes, we did. Alright, and then get to a point as where Bill said it’s like, let's just not take a little data in, let's just not integrate parts of the data, let's take it in real time and do all of it so that the care teams can actually see it right there in front of them when they need it.

And finally, we can build interdisciplinary care teams that aren't just like a nurse doing something over here, a behavioral health specialist doing something over there and a doctor doing something over there and never the three shall meet. But actually, putting it all together. And so, I think if I take one thing away from this, it's, it's like when you get into that get-to mindset and you say, let's not do one thing, let's do several things and let's do them simultaneously.

To me, that's what kind of care worthy family and friends looks like. That's what the numbers on the screen looks like. And perhaps even more important to me, that’s what the photos on those screens look like. That's when you get to hear.

Speaker 1 (Hank)

Thank you, Bryce. I think lastly, we'll kind of wrap up with some of the lessons learned and future direction and then we’ll open up for questions. But Saurabh, if you want to just close out.

Speaker 2 (Saurabh)

So, Tracey, Bill and Bryce great, great stories and insights here, we want to wrap just a couple of key open questions for you. One is, what were some of the most important lessons that you've learned through this experience as an organization or as a team?

Speaker 5 (Tracy)

I think for me, there's two things. The first is planning is key. And so, for this work we had different departments in Blue Shield. We were working with KPMG, we were working with Salesforce, and everyone just based on on where they're working, has a different idea and understanding about how to work in an agile environment. Once we were able to get aligned and really kind of understand how each other were working, you couldn't stop us.

And so, it was important to take that time to go, you know, move slow, to go fast, to be able to make that happen. The second thing that I think is also just extremely important is making sure that you have really good change management. So, we we talk to our people, we talk to our our team members, we talk to our key stakeholders.

Yay, the system is coming. Or, you know, this, there's a whole lot of excitement around it. But I don't think we I think we could do more. Even every time when you think that you've done everything you could on change management, there is more to happen to make sure that you have your business processes ready, that you are listening to feedback and that you are sharing the goals and continuing to just repeat yourself on what you're going through along that journey so you can bring everyone along with you on that journey.

So those are the two things for me.

Speaker 3 (Bill)

I think for me there's really two as well. One is, you know, business clarity on goals and objectives. I think that was our guiding light the entire time. I mean, Tracy mentioned we spent a year doing business requirements and then nine months doing development. That is an absolute shift from the way I see a lot of organizations being.

And the second, you know, really is being very clear not only on the business goals, but on your technical strategy. We were unwavering in our commitment to meet the January 1st business requirements, both from a timeline and capability perspective, and then, you know, no stops you know, to our desire and commitment to ensure we were delivering a technology stack that could evolve and continue to grow.

You know, gone are the days in health care and you often hear healthcare lags, you know, other industries and technology adoption. My observation is slightly different. I think, you know, in 25 years in high tech, working to enable a lot of the cloud technologies and what you get in data and analytics and, you know, just name across the stack.

Blue Shield and other health plans have adopted many of those technologies. But the way in which you implement it and your your clarity on what we call our North Star around continuing to drive innovation and improve health outcomes really sets us on a technical platform that allows us to continue to grow more members we can't afford in health care or any industry, frankly, to deliver one thing and then start over on the next.

And so, it's a continuing building journey to deploy technology. So, you know, in summary, really unwavering commitment to the business objectives and unwavering commitment to driving and delivering the technical capabilities needed to meet those business environments.

Speaker (4)

So, I'll be quick because I want to get to Q&A. I want to get from talking at to talking with. So, I'll talk about building for the future. I think the challenging opportunity before us is to go to scale to, to go big. We put tens of thousands of members on this platform. We're achieving great results. But as you saw at the start, we have 4.8 million members.

So, my goal and my hope and my objective as we move from improving the lives of those, we serve to improving the lives of all we serve.

Speaker 1 (Hank)

Thank you. And again, I wanted to thank the Blue Shield’s of California organization. It's been a pleasure of, I think, the work we've done, and I think the work that we're continuing to do with you all. So, it's pretty exciting. I think really leading. I think the industry and some of the core ideas, the innovations, the concepts and it is definitely a team effort to really get some of these things on and a lot of collaboration.

Thanks everyone for coming to our session. We hope this was informative for you all.

Thanks again to the Blue Shield team as well.