Things You’ll Learn: 

• Passion and a deep understanding of the industry’s complexities, often uncovered through diverse experiences, are essential for healthcare innovation. 

• Data sharing is crucial for improving healthcare outcomes, and California’s recent legislation aims to enhance this through a statewide health information exchange. 

• Payment innovation in primary care reduces administrative burdens, increases provider revenue stability, and improves patient care quality. 

• Behavioral health integration is essential for better outcomes and requires standardized data, financing, and industry alignment. 

• The success of healthcare innovation depends on overcoming policy and industry misalignments that hinder the scaling of solutions. 

Resources: 

• Connect with and follow Shruti Kothari on LinkedIn. 

• Learn more about Blue Shield of California on LinkedIn, their website, and Instagram. 

• Discover more about Women of Community on their LinkedIn, Instagram, and website. 

Transcript:

Rachel Schreiber: 

Hello and welcome to The Spark, a view of innovation in healthcare. I’m Rachel Schreiber, your co-host, and in this episode we’re speaking with Shruti Kothari, the director and leader of the industry initiatives at Blue Shield of California. I’m also joined by Gerald Bortis, the Chief Technology Officer at Avaneer Health.  

Shruti Kothari: 

Hi there. Thanks Rachel.  

Gerald Bortis: 

Welcome to the Spark, Shruti. I’m impressed with your background and your focus on how innovation can improve the quality and availability of care. Before we jump into that, I’d like to hear about the source of your personal passion for improving healthcare. What is that for you? What is the spark?  

Shruti Kothari: 

Well, I think a lot of people in healthcare get into healthcare after they’ve had negative experiences either with themselves or loved ones interacting with the health care as in two words, systems that exist essentially. And I think I’m no different, but I will say that that only gets you so far. If you want to make a career out of healthcare and improving healthcare, you have to stay kind of engaged and passionate and all these things. I will say that throughout my career I have been very lucky to get exposed to different aspects of healthcare and why it’s important to continue improving and how you uncover one problem and then you understand there’s another source underneath that problem, which has three other sources of problems. And so when I look at my own career trajectory, I started off as a health educator in medically underserved communities.  

I went to quality improvement because I saw there were system issues that really affected the community. So went from that frontline to more on the programmatic side. And as I did that for big organizations like Stanford and Kaiser Permanente realized there was really low hanging innovative things that we could do to make a big impact on quality and experience. So then went to the innovation ecosystem as a early stage startup operator realized that perhaps more companies could be funded in areas that maybe weren’t, that could target more vulnerable populations. Went to venture capital as a result and helping to scale innovation of 30 different startups at Kaiser Permanente as venture capital fund. And from there I really realized if you could have the best innovation in the world, the best, but if there are active industry misalignments or policy blocking the scale of that innovation, it doesn’t matter how good the innovation is, it’s not going to scale.  

And an industry like healthcare is so regulated. We’ve sort of built so many workarounds, it’s so fragmented. And so that’s kind of where I am now. But the reason I sort of painted that whole picture is each stepping stone has added to my passion for healthcare and improving. And I didn’t know those things were issues until I was in a role that exposed me essentially to them. So it’s a hard question to answer because the passion keeps coming and who knows what Tomorrow I’ll have a whole, we’ll add more fuel to my fire as I learn more and more.  

Gerald Bortis: 

That’s awesome. Thank you. Yeah, it sounds like healthcare is a endless source of opportunities for doing great work and bringing that passion. So thank you for sharing that. So can you tell us a little bit about the priorities and industry initiatives that you’re doing?  

Shruti Kothari: 

Yeah, absolutely. So like I mentioned, what we specifically focus on, and I want to say Blue Shield of California is truly quite a cutting-edge health plan and embracing ideas. And so the concept of this team truly is to focus externally. Where have we piloted and tested? And we’ve seen really good evidence-based traction, but there’s policy or industry misalignment preventing the scale of those things. And oftentimes this work depends on the innovation team doing the pilots and things like that, or the subject matter experts who are the operational leaders, and they don’t necessarily have the bandwidth to do the external alignment work or the advocacy work for policy at the state and federal level. And so I don’t know, and I could be wrong about this, but I don’t know of very many other teams like this at other health plans where there’s dedicated resources to really move this.  

Shruti Kothari: 

And I wanted to call that out before I get into the areas of focus. I do think that’s an important key here in order to really do this work. So the three areas that we are focusing on specifically are data sharing, payment innovation, specifically related to primary care and behavioral health integration. And I guess I’ll pause there. I can go into what each of those mean too, if that’s helpful. That would be great. Yeah, so data sharing, that’s really our work really dedicated to realizing the full potential of data sharing and advancing data for the sake of health and social data to improve the health of all Californians. That is kind of our vision that every Californian and their care team, which we know includes multiple organizations, multiple types of care providers have the info that they need and the insights that they need to make timely, seamless, high quality, affordable decisions.  

So really that work is very advocacy based and policy based. In 2021, we did get legislation passed in the state of California and we continue to work on amendments to that bill essentially. For payment, it’s really aiming to, it’s looking at value-based payment models in primary care. And primary care is super ripe for that given the amount of things that fall into primary care these days. And also the new technology, like the tools like baseline, it’s virtual care, but there’s so many other things in addition to the administrative burden that’s happening in primary care. So really when we look at it, there needs to be a lot of improvement in this area. So the way what we are doing is we’re aiming to address provider burnout by using payment methods that really allow providers to spend more time with their patients and less time doing these administrative tasks.  

This also has positive impacts on access and equity as it enables comprehensive care that’s really focused on quality outcomes. And when we think about the financial side of it, predictability and provider revenue is really big, and that helps primary care in terms of having stability and business models and doesn’t require a patient flow in and out the door, like a fee for service model Providers can really manage their cohort providers. Again, remember we have a whole care team involved. We have our primary care physicians, but we have nurses, we have social workers, we have a lot of different folks at the primary care level on the care team. And so it’s one different, utilizing the most adequate provider and in the ways that are most appropriate, whether that’s virtual, whether that’s actually coming in the door, all these different things. All of this also helps independent primary care providers stay independent and really mitigating against the negative consequences of market consolidations, which we know can be associated with sharp increases in costs, limited quality improvement, a whole host of other things. And the last is behavioral health integration. And so really this for us is about creating alignment of scalable and sustainable financing for behavioral health integration and creating industry alignment for things like reimbursement and claims, standardizing data funding, resource support, education and training. There’s so much within this too, and it very much relates to primary care as well as integrating and primary care and behavioral health is key to building the capacity and also for improved outcomes.  

Gerald Bortis: 

Awesome, thank you. I’d love to hear a little bit more about data sharing as a priority and specifically how aligning incentives is part of that effort.  

Shruti Kothari: 

Connecting for Better Health is our coalition that we started in 2020. I joined this team in 2020 in July. What a time to join a new company, by the way, but also a new company in a role that’s all about external alignment and engagement with people when you can’t meet with them in person. So a context for folks too on the call that may not know data sharing has been pretty in the state of California. It has a lot of people with a lot of different perspectives on it. So the movement to get data sharing legislation passed in the state of California to have a statewide health information exchange has been happening for over 20 years. So I don’t want to diminish that. There are very passionate people, organizations who have been fighting the good fight for this, but as much in healthcare, there’s misaligned incentives.  

And so there’s a lot of dollars and efforts that go into blocking policies as well that are progressive for data sharing and have so forever really, it feels like we haven’t gotten legislation passed. But what happened with the pandemic specifically is states that did have a statewide health information exchange, they were able to write case studies, show how they’re able to use it in a pandemic in crisis to track, to help people to really help support vulnerable communities too, and how impactful it was to providers on the front line at a really tense time. And so the case was so ripe in 2020 to really push some legislation through and do strong advocacy efforts. So we started a coalition and it started really with Blue Shield of California funding the coalition. Our CEO, Paul Kovich is a strong supporter for years and years for a health information exchange in the state of California.  

And this coalition started with just a handful of organizations. Now, today, present day three years later, it is a nonprofit that stands on its own with several funding streams. It has thousands of organizations that participate. And so we got legislation passed in 2021, which was huge. We are continuing to advocate for amendments to it to make it really operational and targeted and learning from other states and how we’re doing that, all the things. And so your question is, without being able to engage with others, we couldn’t have passed this legislation. We need people at the table for all the voices, whether you’re health plan, whether you’re kind of a community advocacy group, whether you are patients, families, providers, VCs, startups like this issue impacts. So all of us in the ecosystem really, and in order to actually get something passed, we need that loud voice of all of us at the table advocating for this.  

Gerald Bortis: 

That’s great, and I appreciate that you identify the incentives, not just traditionally between payers and providers, but really the broader ecosystem, like you said, startups, investors, existing vendors and so on. So that’s great.  

Shruti Kothari: 

And I want to really emphasize that because I, I spent years in the innovation ecosystem at a well-known startup and then in venture capital. And I saw I purposely wanted to get into this area of policy and industry. I was directly interested in how do you scale innovation? And that seemed to be the biggest issue and barrier for all of our companies at Kaiser Permanente’s Venture Fund. And these were mid-size series BC companies that have already demonstrated success, had big partnerships with health plans or providers or whoever they were selling into, and they were facing this. And so it was like, this is a huge problem. And so I’m saying it again because I think there’s such an opportunity if people are listening out there that work in venture capital, that work in startups, providers, health plans, these folks are, I think already really mixed into the systems of policy and industry alignment and all these things. But I do think that our innovation ecosystem has greater opportunity to step in because it fundamentally affects your bottom line.  

Rachel Schreiber 

What barriers do you see organizations facing when they’re innovating?  I know that you’ve worked on so many projects and really pushed forward innovation, and what kind of challenges have you seen, and then how have they become overcome?  

Shruti Kothari: 

Yeah, I mean, so many.  

Rachel Schreiber: 

Where to start?  

Shruti Kothari: 

Yeah, where to start The first I do actually just again, what I just said. I think entrepreneurs are brilliant and they’re big picture people usually, and so are VCs. But I think you need to have people on your team and people advising you that understand the landscape of the industry, whether it’s the industry misalignments or actual policy barriers. I think that comes too often as like a, oh, we can’t scale this right now. And there’s this big federal policy blocking it, and that’s why we know this before.  

 So proactively get these people on your teams. Again, I’m coming from those industries. It can be very insular. And so it’s like, oh yeah, I want to hire people who have my same background, who have my same perspective. And that’s fine, but you do need these other people if you want your company to be viable and scalable. So just one right off the bat, emphasize that for folks out there building or investing, I think oftentimes people see a big company and think, oh, this is great. If I win this contract like Kaiser Permanente, if I win this huge health plan contractor, Blue Shield of California, and I hesitate to say Blue Shield, I do actually think Blue Shield of California does this very well working for other corporates, blue Shield of California, it’s easier to get in the front door with the right lead because what your title is demonstrates who you actually are.  

But at larger organizations, that’s often not the case. And you will have small companies or medium sized companies even who have limited resources chasing a really big contract with a big provider group, a big health plan, a big hospital system, whoever their customer is. But if any of us have ever worked in large corporate environments, we know that not everyone has a budget. Titles are not reflective of your decision-making power sometimes. And so I’ve seen too many companies get spun up for months, even years chasing this and waste their resources. And it really is. It matters. It matters. It really matters. So one big thing is it’s like don’t get stuck in that cycle. Don’t see the big shiny big contract and chase after it that really be a little bit more discerning about as you engage with people, it’s great. What can you use them for?  

Understand what their roles are. Is it to better understand product development and how to develop your products further? Because they don’t have a budget, they don’t make decisions on vendors. Is it they have a budget and they’re actively looking for solutions in your area? Great. Maybe they have a budget and they’re not actively looking for solutions in your area because they’re building it on their own. But instead of it just being a hard sale kind of line, just use it all as learning and then classify it to what will make you successful. And that’s a lot of different things, not just a sale. And I think people are too shortsighted that way. And as a result, chase dead ends oftentimes that have big impacts. So I think that’s a barrier to scaling innovation on the startup sort of side of it. And then on the internal side of it, I think oftentimes it can be, again, a very large organization, I think it’s different.  

I do think state-based health plans are different because usually whatever you are, you own that piece of it. But if you’re a large health plan in multiple states, you have several people that you have to be collaborating with and talking with internally. It’s almost like you are compromising internally with a lot of different people at the national, regional, and local levels. And so it’s a real killer of innovation oftentimes when there’s too many cooks in the kitchen. And so again, I really appreciate not to, and I mean this as somebody who has worked in a lot of different type of corporate environments, I don’t think Blue Shield of California is that way. I think when you are hired and your role is reflective, I am the director of industry initiatives. I own a budget to execute on what I just mentioned to you guys, our program areas, just like that.  

There is director of community health who has a budget, who makes partnerships with folks like Mommy and a lot of other organizations based on what their priorities are. And her name is Shannon Cosgrove, for folks who are wondering. But it’s very clear. It’s more clear. And I guess for folks as innovation blockers on more corporate levels, it’s like how can you get more streamlined in decision making? I understand it’s a big organization, but I think there needs too often, it’s very messy inside, internally, and it’s not clear. And even having sat in large organizations like Kaiser Permanente where it’s very clear that we need to go down this road, but it might still take a year, two years to make the first few steps.  

Rachel Schreiber: 

And I’ve worked in large organizations and the teams will get in front of themselves and really slow down. And that inertia is really comfortable. And so it does take what you’re talking about of that push forward and that streamlining really resonates. So are there opportunities as a plan that you see for collaborating with providers?  

Shruti Kothari: 

Absolutely. So all of our work, we collaborate with providers. Every single thing I mentioned with data sharing, with payment innovation, with behavioral health integration. And so our big focus really is coopetition. And that’s like collaborating with folks who might be competitor. But oftentimes in healthcare, it can be this, we’re on different sides. If you’re from a provider or you’re from a plan or whatever, and that is not how we think at all. Every single thing that we’re trying to do is to support the ecosystem for all that is involved for the greater mission of all Californians, improved outcomes, quality, access, affordability, all Californians. And that means you have to play with each other and you have to, if we’re being very real, every organization has that mission. We all have that mission. So it should be a no-brainer that this is what we’re working towards and we should be working with each other. But a very simple and superficial way to answer that question is, yes, we interact with providers in all of our work. It would not be possible without providers,  

Rachel Schreiber: 

The people that are delivering the care really important in our communities. So then as a wrap up, what key phrase describes the vision of what you’re creating?  

Shruti Kothari: 

I would say coopetition for sustainable transformation. Sustainable is also very, very key. I feel like we can push through and get workarounds or bandaid solutions for scalability in the moment, but is it sustainable for the long haul? And that’s really important because the way we’ve gotten to where we’ve gotten to with such fragmentation in our system and misaligned incentives is because we’ve had too many of those short-term workaround sort of things.  

Rachel Schreiber: 

It needs to be the long-term. So thank you for joining us today, and if our listeners would like to keep up with what you’re doing or learn more about what you’re doing at the Blue Shield of California, how can they learn?  

Shruti Kothari: 

Yeah, so we have a website, industry initiatives, and I’m sure there’s show notes where they can click on the link, but we do, we have in-person events, we have virtual events. We do a lot of publications, but there’s a lot of ways to engage with us. So any of the things that I mentioned in the work, if it’s interesting to you, if you would like to see how you could help support in any of the advocacy or helping with industry alignment, or if you’re just interested in learning, that’s a great place to start. I know for folks on the line that might be going to HLTH, we’re doing an event at HLTH this year, and so lots of different, yeah, so make sure to subscribe to our newsletter. I also have a nonprofit that I started that is about increasing representation of women of color in healthcare leadership.   

Fun fact, McKinsey does an annual report on women in healthcare and leadership, and it was 4% women of color. Our senior leaders in healthcare, 30% white women, senior leaders in healthcare, and the rest are sort of men. But 4% is really low. When we think about who makes up frontline staff, clinical or not, who makes up caregivers, family or paid, the health disparities that exist for women of color. And so we need more women of color at the leadership table. That’s why I started Women of Community in 2020. But we do in-person events, we do virtual events. We have a newsletter, so you can follow us on Instagram and LinkedIn. And also the links are probably in the notes.  

Rachel Schreiber: 

Yeah, we’ll include that in the notes. So thank you. Well, thank you for joining us today and continuing to inspire transformation in healthcare. And thank you very much.