Advancing and Scaling Innovation in Health Plans: MSK Edition | Blue Shield of California

Our goals should be simple:

• Capture relevant data and insights from every interaction that our member has and incorporate that into an integrated view, while upholding member privacy and security. This way, we can determine whether they are receiving optimum care and services and what we can offer to support them in their health journey.
• Value-based payments. Current payment models for a new digital health solution vacillate between double paying for the innovation and the standard care, which dramatically decreases the return on investment. This leads to abrasion and fragmentation. Value-based payment models hold promise to incentivize positive outcomes at scale.
• More work is needed to develop meaningful success metrics from the patient’s perspective, how to calculate the value of contributions from multiple parties in achieving an outcome and assessing risk factors – and other conditions – that affect their outcomes. 

I am deeply honored to serve as an advisor for the Peterson Health Technology Institute (PHTI). As a former Board member – and foundational investor – of the Institute for Clinical and Economic Review (ICER), I understand the benefit of an objective, third-party entity to assess the value of digital health innovations. Before we introduce something new to our members, we want to be confident that it is safe, effective, and affordable. PHTI provides a valuable service to the field overall and to health plans in particular.

It is not surprising to me that musculoskeletal (MSK) solutions demonstrate clearer benefits when compared to other digital solutions. MSK conditions are defined episodes and have clearer beginning and end points. While they can be related to other physical, mental, or emotional conditions, they have clear outcome measures and defined solutions, like physical therapy, that have been shown to produce benefits. Diabetes, on the other hand, is a multifactorial condition that develops over time and thus requires a range of diverse interventions to successfully address. It involves physical and behavioral health, with multiple actors impacting outcomes in different settings, including environmental and socioeconomic variables.

At Blue Shield of California, Wellvolution is our approach to developing an integrated version of these point solutions to create holistic care pathways for our members. Similar to the PHTI findings, we have seen pockets of success in treating metabolic conditions with Virta, MSK conditions with Sword Health, and so on. More work is needed to convert success in point solutions into a scalable ecosystem that produces the optimal results for our 4.8 million members. It is clear that it will take a coalition of multiple health plans, patient advocates, technology collaborators, providers and health organizations, and policymakers to make a lasting impact on our system. And Blue Shield will continue to push for this systemic change.

This article originally published on LinkedIn.