How do you fix a broken health system? By reimagining it. That means looking at systemic issues, from burdensome paperwork and treatment authorizations to exorbitant drug prices. It means considering all 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.
Health Reimagined
How we’re getting there
Every program we’re launching—whether it’s a new virtual care plan or a simpler digital 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 make behavioral health care more accessible by enhancing our mix of in-person networks, virtual care, and resources for self-care.
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 standing up new manufacturing and distribution channels to bring low-cost generic drugs to our members.
Exploring new models of care, payment, and outreach
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.
Have questions on how Health Reimagined can help your organization?
1. Based on preliminary findings from the CHA program.