Breaking Barriers: How Industry Collaboration is Transforming Healthcare

Speaker A: Foreign. Nice to meet you and thanks so much for taking the time to join Architect Health's the Front Door newsletter.

Speaker B: Yeah, thank you for having me. I'm excited to be here.

Speaker A: Wonderful. So let me share a bit of context to our, uh, podcast audience. My name is Soham Shah. I'm the co founder and CEO of Architect Health. At uh Architect help you improve cost savings and relieve point solution fatigue for health plans by aggregating, evaluating and managing virtual care. Point solutions as the front door for digital health. We cut through the noise of these point solutions so plans know which ones truly add value. In our newsletter series, we interview healthcare executives and founders on their experiences with healthcare innovation, digital health and preventative care. Our goal is to identify pain points in these spaces and paint visions on how to address them, hopefully inspiring change makers in our industry. Today we are fortunate to have an incredible guest Healthline executive and health equity leader, Shruti Kothari. Shruti is a healthcare transformation advocate. She supports improved experiences for patients, families and providers. Shruti has worked as a health educator, community mobilizer, quality improvement leader and early startup, uh, operator. Clearly a conduit between large systems and the innovation ecosystem. In this capacity she has worked with for the American Cancer Society, Stanford, Kaiser Permanente and Blue Shield of California. Currently, Shruti leads industry initiatives for Blue Shield of California where she's focused on scaling and sustaining healthcare transformation through industry alignment and policy movement. Shruti is also the founder of Women uh, of Community, an organization committed to increasing representation of women of color in healthcare leadership, and the co founder of Crown Society, a company whose mission is to support the young caregiver community. Shruti is also on the board for the Family Caregiver alliance, is a board advisor for the Asian Pacific Fund, and is an advisor for the End well Foundation, Scale Health and reverence. In 2022, Business Insider named Shruthi is one of the top 30 under 40 leaders in healthcare. And in 2024, Rock Health named Shruti has the top 50 in digital health, which is specially apt for what we're talking about today. So thanks again for being here. Shruti. Ready to get started?

Speaker B: Yeah, that'd be great. Love. I think I need a like red carpet rollout bio readout everywhere I go.

Speaker A: Oh, definitely. I think in just normal, uh, zoom calls when you're meeting with someone, that should be the first five minutes. Um, it's fantastic. I need to get to the point where I can do that myself.

Speaker B: You're there, you're there. We all are There I believe that.

Speaker A: So let's start off. What is the origin of Blue Shield California's industry initiatives? What's the purpose behind it? How does it differ from the typical health equity and quality teams within pay organizations?

Speaker B: Yeah, this is a really great question and I would even add another team that it differs for which is like the innovation teams usually at an organization. Um, and I'm going to be as bold as to say I think every organization needs a team like this and it's pretty forward thinking of Blue Shield of California to resource a team like this. So you know, the concept here really is around um, when we look at innovation or transformation, every organization we have the, when you're in health care you have the goal to have better quality access, um, you know, care, experience all of these things. And then we test and pilot a lot of different things around what we call transformation or innovation. Kind of name it what you want at whatever organization. But a big challenge in our healthcare ecosystem is that we are so regulated, right? And we are, we have a history of kind of workarounds which lead to a lot of fragmentations in the system generally speaking. So when we think about these concepts of where we're trying to improve um, you know, I'm going to call it transformation, lump sum, that word of when we're trying to improve things and then we're testing and piloting um, different operational changes uh, to improve these things that I mentioned earlier. We can have oftentimes when it gets to the point of path pilot and there's good evidence and we want to scale, um, one of the barriers to scale can be either policy issues that exist either at the state or federal level or both, um, or even just industry misalignments that are prevent, preventing the skill, um, outside of your own organization. So you know we are a collaborative industry. We rely on each other systems providers, plans, um, advocacy groups, uh, all sorts of things. Right. Um, and so when there are so many diverse players in the ecosystem and there is regulation, um, you know it does lead to fragmentation which then hinders uh, the scale of transformation. So that's like the nut, like kind of the, the meat of the why industry. When we want to scale, we can't scale because of these things. So then who works on those things? We have our government affairs department which work on legislation usually right at the state and federal level. We have our operational teams which um, are comprised of quality, um, uh, innovation. So on that are testing like looking at the data, testing the solutions, things like that. But then who's focused on actually moving some of the barriers to scale when we're at that point. Um, so that's what industry initiatives really focuses on. And it's really big on um, collaboration and I'm going to even stay a step further and say cooperation which is basically collaborating with folks who may traditionally be your, your competitors.

Speaker A: Got it. That's super interesting. It's almost like creating branches from the learnings of Bushel California out to the broader ecosystem and just this focus on California or a certain kind of business unit or collectively and across the nation.

Speaker B: Yeah. So um, the way when so this team started, um, actually the idea started uh before the pandemic. And uh, and it came off of a leadership executive offsite um where our senior most leaders like our CEO and I say this because it's really important for a team like this to have buy in from the top, top level leaders and also then get resourced as such as well to do the work. Um so it was a very serious concept right from the beginning. It wasn't like ah, oh this would be a nice to have. It's like ah, we must actually have. We have these really important goals on transformation and we must have this function in order to scale it. And so that's kind of the start of the team. And it was right on the foundations resourced really properly with the right support internally um and with the right resources scientific. So then we could do the work externally. Um and so for your you know to think about where do you focus then on. Because there's a lot of different areas you could possibly focus on. Um, we think really strategically about this of like again we have um, like on our team now we have created like a very rigorous excel of like criteria of when we take on new, new program areas. But I just had to like generally speak it's has to be something that we have tested and piloted and we have good evidence around that it is good for the ecosystem. Not just for us but all of our partners. Um, whether it's you know our patients and members or provider groups we're working with whatever it might be. Um and then there the reason that we cannot get it to scale is because of an industry misalignment or a policy issue. And that can either be state or federal. Um, so really it's either or um. And that's where we come in. And then it also has to be something that is attainable because there's a lot of um, industry or policy issues within our ecosystem that you know are very layered and may, may be um we certainly when we take on programs we work on it for years but it is um, sometimes there's just hairier problems that we will, we will kind of bypass to get to more lower hanging fruits for our transformation agenda. So what we focus on um, given that criteria. Oh also as an organization we have to be like committed to that. Like we have a multi year strategy and resources on the operational side. So we focus on data sharing, um, advanced um payment models and specifically looking at primary care right now um and integrated behavioral health are all of our areas and industry initiatives.

Speaker A: Awesome. That's super enlightening. I think this transitions very nicely to kind of an example of this which is um Lucia Call of California helping launch a nonprofit Connecting for better health C4BH UM to discuss policy development, share the latest evidence, develop collective outlook to advance data sharing California in a form style setting. What sparked the need for this and how Lucia California continuing to increase data transparency and interoperability.

Speaker B: Yeah and I'm going to take a step back for a second and um, and just say like how important data sharing is. I don't think that we really realize it. So you know as somebody who's come from startups and um, venture capital and different areas where we all get very excited about very innovative cool things. So like I will throw out one. One thing that we've talked at nauseum about recently is AI right, like AI, AI this and that. But you know when we think of some of the cooler things we can do in innovation if it doesn't have a foundation of simple the ability to share data like with the right players in the system a lot of this is just fundamentally not possible. Right. And so we get ahead of ourselves oftentimes with like these really cool innovative ideas. But structurally in healthcare are we set up to really adopt and scale these things is like a big question and like just the, the number one foundational thing is data sharing for so many things. Um so I highlight that because I think I hate using this word but like uh, I'm going to use it. It's like it's not thought of as like sexy like right like the sexy thing to talk about.

Speaker A: Arguably a lot of things that payers work on is not considered sexy.

Speaker B: Right? It's not sexy but it's like the plot is like the backbone you need it do like right like and so um, so anyways like uh, so so we at ah Blue Shield of California think that you know this concept of having a health information exchange is, is um really really important um for Everyone in the ecosystem. And of course, you know, we're thinking about this in a really strategic, mindful way. And what that means is it's not just us thinking about it, right? Like, we need to have all, all the players at the table, folks who are maybe traditionally our competitors, folks who are collaborators, um, advisory groups that represent different folks in the ecosystem, like patients, like hospitals, like providers, like everyone. And so Connecting for Better Health was really the vehicle in which to do this. So when we sort of helped launch um, Connecting for Better Health, this was back in 2020. And I will say this for folks that also don't know the context of data sharing in the state of California, which mind you, is like, we're the second largest health, um, plan in California. We cover about 4.5 million lives. So it's lots of people. Um, historically, California has been a state where there are so many people passionate about this topic of data sharing. And they really have been like, out there trying to advocate and champion for this for like, like three decades, really. Like, uh, and, and because of the misaligned incentives, you know, we just haven't been able to pass legislation historically. Now what's different now and what's really ripe for this transformation is it was the pandemic. There were states that had data sharing mandates in place for years, like Nebraska, North Carolina. They were able to demonstrate how they were able to use their statewide hie for better vaccination tracking, for better, just resource allocation to vulnerable communities, like you know, all the different things. And they, um, some were even written up in case studies, um, and like at McKenzie in different places. And so this really set up a really right time to push even harder for a data sharing mandate. So when we help launch the nonprofit um, Connecting for Better Health, it was the perfect time. And you know, it went solely. It went from just like two, three organizations to now like thousands of people. And we did get legislation to pass in 2021 and we continue to work on like amendments to that.

Speaker A: Ah, that's super exciting. And uh, it's great to see people joining forces together, especially because we know for health data exchanges you need to have alignment on the provider side, on the payer side, and people often forget on the patient side as well. So, um, it's great to see that all come together. I'm curious, you know, tying to what has emerged from the pandemic? Um, how has your view of digital health, these telehealth apps, virtual first care, changed over time from the pre pandemic days to the post pandemic days looking at your crystal ball, what does the future hold in store?

Speaker B: Yeah, so it's very interesting. So like one, you know just what we talked about how important data sharing is actually for all of these tools as well. But another area of focus for us is advanced um, payment models I mentioned in primary care. So you know, one thing that we saw the need in the pandemic, right Was the ability to have different types of care. Right. Like when you, when you want, like virtual whatever it might be. Um, uh, we also saw the need to have the care team be whoever the providers really feel are the right care team. And so when we think about this, our traditional fee for service models don't work. Right? Like it truly doesn't. And we even think about primary care today and all that is kind of absorbed by primary care. Our integrated behavioral health area is kind of focused on this as well where um, right now primary care often serves as the front door for, for mental health and wellness as well. And so um, and there's, so you know, I won't go into it because I'm sure folks who might be listening to this are already attuned to some of these challenges of how it's led to the burnout of clinicians. And also in modern day what does primary care actually look like and is it being financed um, appropriately as a result? Um, and so when we look at like value based payment models in primary care, a lot of that is um, freeing up like you can use different modalities of care. You can, you can define as a provider who's on the care team and how folks access it. So when we were um, piloting for example in, in primary care, amazing outcomes all around, whether that was quality and outcomes for the patient, the member side, um, or satisfaction of our providers that we're contracting with. But the reason why this is like one of our big areas is we are one health plan. And even though we are a large health plan, we, we're just one health plan for big provider groups to change how they contract, what they do, the backend systems. And so we need other health plans with us in this journey. Um, so we're not just like one out of four health plans it might be contracting with. So that um, we did get alignment from multiple, you know, years later, same thing, we kind of convened payers, talked about value based payment models. How do we contract for this? Um, agreed, released a public MOU and now we're getting ready um, for, for launch um, for next year. Um, but I'm saying this to Say when I think about digital health, I think about the more and more you can get this what I'm talking about like payment model and how you think about advanced payment models in different sectors of care for the sake of, for our work. Right now it's really primary care but when it is not fee for service and it's more like based on outcomes and different things, think about right, like all the digital tools that could be utilized by the provider groups. Think about, okay, now people are going to get actually reimbursed um, as a provider as they think strategically instead of it just being these like one off fee for service sort of things. Um, and it's also then what are the digital tools needed in an ecosystem like that? So like for example for our advanced primary care work, I mentioned that several health plans have come together and we're now going to come together on one system, it's called Cosiva, um, where now we have data, transparency of outcomes and different things. And so there's like a sharing of data, there's um, a digital, it's become more digital in general. And so I think when we think about digital health there are the really cool shiny objects and then there's again the structural things that are very needed, um, that might not be as cool and shiny but that are the backbone of basically being able to implement even more digital health tools. Right. And so um, I think it's complicated and I think that the fatigue that you mentioned is real. But I think that also comes with a lack of our industry being really aligned and how we operate. And it's to the very kind of foundations of how we pay and whether it's fee for service or value based, um, what kind of autonomy a provider has in deciding what tools to use virtual or in person, what the care team looks like. And so um, I think when I look at the crystal ball, I think if we as an ecosystem can learn how to cooperate better and kind of really scale these, these things that we all talk about like value based payment models, um, like data sharing. It's endless. The possibility of what digital health can do. So urge the message to folks listening is like urge them to really um, understand what their, what they would like a future state to look like in digital health, how they would like to see their company supported and easily integrated and all these different, and actually get on coalitions and convenings to advocate this. So they're part of the table designing.

Speaker A: That's, that's fantastic. And um, that infrastructure piece is super important. It's almost like in today's environment, we're running before we can walk and the pandemic was us being forced to run with telehealth without really understanding the implications. The payment models. How do we actually track and measure um, value and ROI from these solutions? So I actually want to hop around and kind of get to one of the questions that were taking later in the interview. But I think is exactly what you're talking about right now, which is digital health and value based care are the two most talked about advancements in modern healthcare today. Where do you see a natural intersection between the two? Can value based care arrangements drive the adoption of digital health and vice versa? How is your industry initiatives team thinking about the payment innovation in VBC for digital health? Uh, just something to add for context is Sward Health recently came out saying they're going to be doing all of their contracts on vbc. There are starting to be some collection collectives like the Wonder Woman collective that's focusing on bringing maternal uh, care and women's health solutions into one organized community. So I uh, think there's a lot of traction happening here and I'm curious to get your thoughts on that.

Speaker B: Yeah, I mean value based care and digital health innovation really do go hand in hand. You know, value based care arrangements create financial incentives to adopt digital health tools um, that can streamline care. Yes, for sure, uh, increase uh, patient engagement, really improve outcomes. Um, and really uh, simultaneously too digital health enables more effective value based um, contracting and care by tracking key metrics and enhancing data accessibility. So like I mentioned with our coseva platform that we're contracting with, with our things, um, and so you know, when, when we think about that on our team industry initiatives, um, payment innovation is really like value based care is at the cornerstone of achieving sustainable high quality care and is really like when people talk about. I like to say this too because I do think that oftentimes people use different words for similar things. So, so like value based care, um, payment innovation, advanced payment models, like all of sharing. Yeah, yeah, right. Like it is, I think it can get like it's hot. It's, you know there are so many things you can get so nuanced in healthcare and you have so many subject matter experts of very specific things that I just, I want to call that out because if you do are an innovator, um, and you hear these different term and you know people, even for data sharing there's a lot of different words for data sharing, interoperability, health information exchange. So there's you know all these key buzzwords. But in payment, you know, we do have a lot of, a lot of people talking about it. Um, and it is kind of again, hand in hand with digital health and both support each other. Um, and you know what we think is like rethinking payment models, we can help ensure that primary care providers are like really empowered to focus on comprehensive patient centered care, um, that really leads to health outcome improvement and efficiency. And so for us, our role is like, how do we actually support that in the ecosystem of scaling? So that's why we had invested so many resources. So like the work that we did in advance, payment models, like this is something that was like our operational teams were actually testing with provider groups and um, we were one of the only health plans in the state of California. Actually testing. While many people were talking about how, um, advanced payment models, uh, value based payment models in primary care are super important. Blue Shield of California was one of the only ones. So after a few years of testing really good outcome data, um, and providers liked it, patients liked it, we liked it, everyone liked it. But this is where that piece came in. But we're but one health plan. How do we get other health plans? So then it was almost like, you know, we can't, even though we want to scale, we can't, we have to gather health plans at the table. So then it was in 2020 starting this work of um, working with Integrated Health Care association and pbgh, ah, to get multiple health plans around the table. And we started from like page one which was let's look at different payment models out there. Let's look at the evidence and the data of what payment models look, um, work well for value based in primary care. Now we were already testing, so we were like, we think this is great, but we understand that we are now getting multiple people around the table to do this. We have to start from like kind of the first concept of it and all to the same payment model. Right? So this work and kind of starting from day one with payers, other payers around the table, took almost three years. Like we were sitting at the table, uh, looking at the evidence. Then it was like, okay, we believe in this, this one, these particular aspects of the model. What could we agree to, to do together? What provider group would want to engage with us to test it as a group? What would we need as far as like the digital infrastructures to make this happen? Um, and so that's why it took three years. It takes a long time, but it is, it's groundbreaking. When you're able to do it because now like we are fundamentally we have several health plans and we're going to be contracting in a whole different way. Right. And I think there was this article that came out which I love, it was by Business Insider and it was like, it was right when Amazon had made some really like big lofty announcements

Speaker A: around health and uh, one medical and the whole thing.

Speaker B: Yeah, exactly. And it was like, it was something like everyone thinks Amazon's gonna disrupt healthcare, but it's really these like health plans that are working together for advanced, you know, payment models. And it sure enough what happened, you know, on the Amazon side. But like this is what I mean. But it's not the shiniest star oftentimes that can make the biggest impact. And I just want all your listeners who might be in this space either chasing shiny stars or creating shiny stars, um, to kind of hear that message and uh, think about really like in their own ecosystem, how can they get involved in some of the systematic things? Because that's truly at the end of the day what's going to actually allow for their own companies to scale. So that's amazing. You mentioned Sword Health is, you know, going to be contracting. Um, but I would also say because, you know, when I was in venture I worked um, with companies like Omada and things like that that were also, um. So I'd be really curious to see how that plays out in terms of um, the folks that they contract with, if they have the infrastructure to even engage in that and like. And you know, also where can Sword Health and other companies who want to move in this direction actually get involved in more of the policy movements around this and the industry alignment movements around this to ensure the future of um, executing on what, on what the vision

Speaker A: is 100%, um, to take a contrarian view, not me personally, but one of our former interviewees, um, was Dr. Sachin Jain from SCAN and he mentioned that the innovation that's happening in payment model for BBC is something that everyone's talking about. But then when people actually start to get to contracting, they realize it's harder to track actual measures of outcomes. And that's a whole separate job which then can actually eat away at some of the time or resources or money saved from going down a value based contract. So uh, I'm really curious to see how the infrastructure, as you mentioned before, is really going to be built out over the next couple of years to sustain these types of models. Um, but it's a very setting time.

Speaker B: I mean that's. I Mean, it's a great point. And this is exactly why we did the work that we did. Right? Because that's exactly right. That's why we couldn't scale because it was like great, it's pilot form, we have the evidence. But the resources needed on the provider side to start contracting. Right. We needed other health plans. So um, it's a, it's a good point that he makes and it's also the very reason our team exists and is working on this area. Right. And so um, so my call to any contrarians out there that land side is come join us then and come, come, come work with us on building better infrastructure and let's actually put our kind of money where our mouth is when it comes to value based payment, uh, models.

Speaker A: I love that we need to see more industry initiative orgs within these, within these payers. Um, you touched on primary care and used that as like a kind of foundational example. I know you're a big proponent of both primary care and behavioral health. How can you better integrate the two? And how can we increase access to care for that? Um, how does Blue Shield California think about partnering with telehealth vendors to support these initiatives, especially when there's a dearth of providers, local providers that are doing this kind of work?

Speaker B: Yeah, I mean this is like, right. This is a huge, like 60 million US adults live with um, some sort of behavioral health condition that really requires like medical assistance. Um, and so yet when we think about the stigma and the socioeconomic factors and navigating um, caused by our fragmented system, if there's any key buzzwords today that I want people to walk away with, it's like cooperation, industry misalignment and fragmentation. Because I keep saying these things right, because they're, they're real. Right. Uh, so when we think about the integration of you know, behavioral health into primary care, that, that does hold the power to change our systems and have more comprehensive, timely and equitable whole person care. Um, and there's numerous studies out there too that kind of support this claim. We know that. Um, and so for us, you know, our integrated behavioral health um, work is really focused on the collaborative care model. And when we think about the enhanced level of coordination, um, it's really what's the financing behind how things currently work. Um, and we know that collaborative care model is like, it's a well researched. If you Google this, if you kind of look at um, academic publications, it is kind of the example of what is kind of the best approach when we think about primary care. And, and integrated behavioral health. Um, and so when we look at long term, if we want to scale and sustain that we need better financing around this. Um and we need it not to be. It has naturally evolved where primary care has become the front door for behavioral health. Um but the way in which we contract hasn't supported it. And so that's what I think the key area is in looking at it is in setting up the structure, how do we set up the financing around this to make it sustainable long term. And then when we look at like digital health solutions, right, like um, we and other health plans offer a multitude of telehealth services to our members. Um and you know for Blue Shield of California we include that at no, at no cost to our um and so you can like connect with a nurse or you know a partner through Teladoc for with us. Um, you uh, can kind of schedule appointments with psychiatrists, psychologists, counselors by the phone, video phone oftentimes like low or no, no copay. Uh so. And we also like contract with folks like Solara who have a platform of digital health, um, tools and services. Um and then we also have different population based things, um, like maternal care, things like that where we go contract with multiple different kind of providers to, for digital tools. Um, and then also just things like doulas and you know a lot of different things. But I, I'm, I say this because there's so much testing that goes on and some of these are testing, some of them are absorbed just natural operational practices that we do. Um, but it always goes back to the unsexy thing like which is long term all. And I say this, not just Blue Shield but all of us in the ecosystem care about this. It's really about if we want to integrate behavioral health and we think about the integration of primary care and behavioral health financing is the thing that we have to get really right around it in order for it to really be a long term like to create the idealized vision that we all have of it.

Speaker A: Yeah, definitely. I think um, we've seen that especially in the behavioral health space over the past couple of years with the formation of health companies like Headway that are really trying to create this network of providers that are all willing to kind of come under insurance and kind of connect the ecosystem. So I think with the direct primary care and um, virtual um behavioral health space there is going to be some kind of union that happens. Um, but at the end of the day the payers kind of need to be at the center of it to Think about what is that model? How does it actually also drive some of the value based arrangements that you were talking about earlier where you can actually see real results and outcomes, um, downstream, um, in members that have more chronic conditions. Um, so I think that's totally right. Cool. Uh, next question. Um, the concept of point solution fatigue has been voiced consistently by payers, providers, even patients themselves. What approach has Blue Shield of California been taking to address that? What novel approaches might you recommend to plans combating this problem today?

Speaker B: Yeah, I mean it's a great, I mean not to be a broken record, but it is like the fact that we don't work with one another oftentimes. Right. Like it is. So I hope, I mean uh, I'm sure like you picked up on this now listeners have but like industry initiatives and what we do there is like so different of a function. And we constantly think about cooperation. How can we cooperate with others in the industry, some who are our partners, some who are our competitors. Right. Like, and it, it's wild when we first started doing this work, um, like we would have to sign NDAs when talking to like other health plans and things like that. And it was, even if it's just like very minimal, basic conversations, not getting to anything, you know, secretive at all. But I think that just speaks to the state in which health plans have worked with one another traditionally. It's always been seen as like a, almost like a competitor sort of mentality. And even, even with folks that aren't competitors, there can often be in our ecosystem, um, like what are they? What's the saying? You point one finger and then three are pointing back at you. Right. Like, like it is, it's just the way in which our industry has kind of, kind of emerged and evolved. So like this is the fact of like working with each other shouldn't be a novel concept. And so, but it's really interesting to me to see the digital health ecosystem evolve in that way too when they, when really if it's like a cutting edge new like area of healthcare, like why not design systems to be more collaborative with one another and all the different things. But I do think that this like foundational healthcare thing of like, you know, where we don't work with one another, like almost for me it's a little bit into that digital health world at uh, times. And so um, so it is something that I think that no matter what subsect of our industry that you work in and our healthcare industry, whether it's digital health, whether it's health plan, whether it's providers. Like, it's something that I think that we need to be thinking about more and more is how do we collaborate with one another? Um, and not just for collaborating with folks that we traditionally collaborate with, or like, it's easy to collaborate with, but even how do we collaborate with folks that may traditionally be our competitors, um, or folks who we see slightly as competitors. Um, because it is just so fragmented that there is no way around it. We can't get around building the systems that we want without working with one another. And I'm a broken record for this because it feels like even though it's obvious and we all know it, it's still really hard to work with one another. And, um, even like, were you at Health Health Conference?

Speaker A: Yes, I was.

Speaker B: So you walk into that massive, like, conference, like with the web. Yeah. All the companies in there, and then you kind of go to different booths and you're like, uh, ah, interesting. Like you're kind of doing the same thing as this other booth, but like slightly different. And not again, like, Right. Like, it is, it's like a real thing. And I mean, the, the fact that that conference is now whatever, 10,000 people more and they can raise venture capital dollars to.

Speaker A: You got acquired.

Speaker B: Like, oh, they got acquired. Okay.

Speaker A: As a conference, getting acquired. Whereas, uh, a lot of healthcare companies today are really struggling to get acquired. Right.

Speaker B: In a sense, it's like, it's. It's a very interesting thing to like, think about when it's like. And then that's just like. And then you think about like these front doors, the health plans, the, the provider groups that these companies might be like, pitching to and going forth and like, and it. And it is sort of like, oh, wow, we, we really need to be more streamlined as an industry. Ah, we like, we really need to like, if our goal, if our ultimate goal, if you're in healthcare, I think that you have some sort of mission or passion that brought you there. Right. Like, whether it's personal experience or just you want to make systems better. But if that is our ultimate goal, regardless of the seat that you sit in in healthcare, then it is imperative that we learn to work with one another to make things easier for everyone in the ecosystem. Whether you are a, uh, health planner provider who is having to like, distill all the innovation and figure out what's right for you. Whether you're, you know, a provider, uh, that's burnt. Their systems are burnt out from trying to figure out the back end to absorb some of these innovations. Whether you Are, you know, ultimately the member of the patient who's receiving the lack of access or bad care, whatever. Like, like there's, we all hold that responsibility if we want to stay true to our mission.

Speaker A: Yeah, definitely. I mean we've seen this um, in the space that we're working in right now, which is um, when a lot of health plans are starting to think about how do they build their own digital health hubs. And it's ambitious to say the least, to see some of these plans trying to leverage their existing IT teams to build API integrations with every single telehealth vendor that they're working with, which we've seen consistently does not work. And it's not necessarily a realistic feat. There needs to be that coopetition which I think I'm going to borrow in this use case, um, where you have a centralized organization that is doing that work but enabling the value that these plans are trying to build for. So it goes back to that buy versus build mentality that I think every payer is struggling with. And it gets to a point where sure, perhaps a blue shield of California has the ability and resources to. You're not just thinking about Blue Shield of California, you're thinking about everyone in California, everyone across the nation that leverages um, some form of health care. And so at that point you need to think about the other ecosystem, um, players that are involved in that care. So I really like what you said there. Um, I want to take uh, um, a higher level perspective, um, that maybe a little bit more relevant for our digital health and health tech audience and valor that are building in this space. Um, from the payer perspective, what roles do cost savings, quality of care and member engagement play and planned motivation to onboard and partner with digital health and health tech solutions? What would you recommend to a uh, founder that is building in this space today on how to best collaborate and work with a payer?

Speaker B: Yeah, so that's a really great question. And you know of course like access, quality, equity, these are all priorities that we all care deeply about. They're in every single health plans. Mission likely. Right. That you'll read. And so um, you know digital health is certainly um, part of the equation and it's hard to talk about impactful digital health without also thinking about the other tenants. And so you know we mentioned um, like data sharing for example as like realizing the full potential of data sharing, um, and advancing health, um, um, and that also includes like social data, um, when we like so. Right. Like we didn't even get into how equity Plays into all of these things that we're talking about where it's primary care, about digital or sorry, data sharing, things like that. But I um, I think you know, it's great to demonstrate how you might be able to, to do value based care and all these different things. Right. But like I think as we talked about fatigue of all the solutions and different things like that. So it's also like demonstrating what is your value. Like how are you engaging in the ecosystem to build better ecosystems currently? So like yes, you have the best tool possible to sell into this health plan or whatever. Right. Like, but it's also like do you understand the framework in which something like your product needs to be implemented? Do you understand how complicated like Phi is within the organization you're trying to sell to used to work for Kaiser Permanente. That was one of like the biggest issues with companies was around, it is around data sharing. Like actually like our data leaving the company coming back in, things like that. And it will be at uh, most health care organizations given you know, PG and how um, regulated things are. But I think that there was sometimes, always as uh, somebody who's worked at very large organizations that get pitched at a lot by digital health companies, there can be sometimes an oversimplification for how their tool or product can just fit in to like, you know, and it's like you could have the best tool in the world, the best tool in the world, but if it cannot be easily absorbed into how the operating systems already are and it hasn't thought about the burnout of the data coming back, yes, your data could be helpful but like how is that being absorbed back and like into operations and you know, is that, is there a burden on um, systems that are already like really burnt out and broken? Like you know, primary care we talked about. Right. Or is it helpful and supportive and what do you know about it? Like what do you know about the surroundings of it to get it to be functional? And so um, I think that's where a company can really shine and showcase to someone they're trying to pitch to is how well they know the ecosystem and how a product like theirs or you know, a service like theirs, how easily it can be adopted into current systems. What do they know about the current systems of whoever they're trying to pitch to? How do they see the future state and scaling it and how are they working to support a future state? Is it that they are also at the table advocating for data sharing? So XYZ vision, are they a part of, you know, some Systems that are already in place in testing. Like, so anyways, it really just depends on like, whatever it is a person selling, but it's it, uh, knowing that on the other side, you have so many companies coming to pitch to the same person that you're talking to, and they've likely talked to many people who don't actually understand the infrastructure very well. Um, and so, um, unfairly, they might assume you might not know it, but then it's like, how can you demonstrate to them that you do know it? And also if you don't know it, start getting to know it and start being, you know, like I mentioned at the table with other players who are trying to advocate for change, whether through policy, through industry alignment, whatever it might be, so people understand you're part of the, you're part of the movement to make the ecosystem better in whatever area that you are in.

Speaker A: It's not just about the value that you're demonstrating. It's about how seamlessly and sustainably you can fit into that organization. Um, which is why we're seeing a lot of solutions of trying to figure out ways to be low or low implementation. No. Or low integration. Um, so I totally agree with what you're saying there. Um, we're getting to the latter half of our, um, or the latter part of our interview. Um, I want to talk about an article that you wrote so you in Culver, California, CMO, uh, Dr. Monica Soni, who is a fantastic person and one of the most eloquent, um, speakers I've ever met, um, co authored a Fierce Healthcare article embracing the complexity of lived experiences in healthcare. Both of your personal experiences were foundational to the work that you've committed your lives to progressing. How can the healthcare system better understand the needs of members and provide personalized care that closes these gaps? Um, from your shared and lived experiences.

Speaker B: Yeah, thank you. Thank you for bringing that up. For listeners that don't know Dr. Monica Soni, she's one of, like, there's a handful of people and I mean, there's a lot of really amazing people in healthcare, but she blows my mind, like, how humble she is, how smart she is, how like, mission driven she is. So, um, she's really kind of a fantastic person to, um, honestly just even just follow like on LinkedIn or something like that. So highly recommend that to people out there. And yes, I was very lucky to get to co author a piece with her. And it's funny that there's just a kind of like a little bit of a backstory of how this happened Is, um, we. So part of our work that we do at industry Initiatives, um, uh, is we do publications, but we also do, like, events and stuff. And so she was a panelist on one of our events on data sharing and healthy. Yeah, and we were, um. It wasn't even. It hadn't even started yet. And Monica and I were just like, kind of in like, the green. I was the moderator. We were just chatting and. And she had brought up about, like, how she was a medical student at Harvard and like, how, though she had family members, like close family members, like in transitional housing and living in cars, and how, like, someone might see her as a Harvard medical student and like, you know, just assume certain things about her when she's pretty close to people that she was trying to help more in a population base. Right. And so, um, and how these stories really matter in. Within healthcare, basically, like, how our stories matter. And, um, so it was just like such a wonderful, rich conversation. And we were like, as two people who tend to look a little differently than, uh, the majority of leadership in healthcare. And that's no secret. You know, there's lots of studies on. Right. Leadership makeup looks like, um, and how we have seats of power, or I should say we have seats at some of these tables of power and privilege. Right. Like, and how do we actually bring our own personal stories into the mix of. In our narrative to push for, um, a greater sort of the greater mission. And so that's kind of the backstory, which I thought was a really cool, organic way because we all need to find our people and healthcare. Healthcare is big and, Well, a lot of people with a lot of different mission, uh, and interests. And so anyways, um, I urge your listeners to find your people in health care. And I'm Monica. Sonny is one of mine. Um, but. But essentially. Right. This piece was a little bit of a narrative of our own stories. M. But also too, there are a few ways in which our health care systems can really understand the needs and close gaps. Um, and it's really through proactively closing these gaps and empowering primary care, uh, and kind of the work that primary care does and prioritizing data sharing, um, that we can get to our ultimate goals when we think about equity access and closing systematic gaps. And so Dr. Soni in the piece really speaks, um, uh, to this in her work, uh, about not making assumptions about populations, um, and that this often happens when you have people that don't look like the populations we're trying to close the gaps in, like, at. At at the tables, like making the strategies, um, and inequity affects different populations differently too. And so like, you know, for example, some health insurance marketplaces have begun to automatically enroll people, um, when they lose eligibility for Medicaid. To fix, uh, you know, to fix this issue of like, when we think about how do we reach certain populations and um, the onus of signing up and recognizing how do we provide more seamless, integrated experiences for everyone. Um, so like, that's just like one example, but we talk about multiple examples like this. And it's in, in what's it's rooted in is assumption, like not making assumptions and actually designing and building for populations. And if you aren't from that population and you don't have team members from that population, make sure you understand the populations pretty well that you're trying to designed for.

Speaker A: I love that. Um, I spent a lot of time working in the philanthropy space prior to building Architect Health. And one of the case studies I remember most clearly is organizations in the UK that were basically investing in all these malaria nets and sending them out to Africa. And they thought that the case of the rates of malaria would decrease over time. But actually in uh, fact happened when they visited some of the tribes that they were sending these nets to was that they were getting a lot of complications, health complications. And the reason was that they were using the malaria nets to catch fish and they didn't necessarily care about the malaria and the mosquitoes. And obviously the malaria nets have certain types of pesticides and residues and that would actually cause infections when they're consuming the fish in the river. And so part of it is like you're saying, like really know your member, know your who you're trying to help and figure out how to kind of focus on improving their lives in ways that they want versus rather than what you assume is going to be the best fit for them. Um, so I want to get to the second to last question here. You know, kind of talking a little bit, um, you know, separately from just the health care work and digital health work that we've been talking about. You're a leader both in and out of the health insurance ecosystem. You launch women of community or are an advisory council member for the Asian Pacific Fund, co founder, Crown Society and Board of the Family Caregiver Alliance. What motivates you to support these initiatives and why is it expressed in these ways? Um, does that actually, you know, touch into some of the work that you're doing with industry initiatives?

Speaker B: Yeah, I mean, it's honestly all connected at the end of the day, right. Like so my like my mission as a human is like to just do the best that I can do. Right like and in the systems in which I have decided to focus my time and energy are health and health care. Right. Um, and so though I should say healthcare as in two words and so like it is um, so everything I do is for that mission and everything I've done in my career trajectory has been for that mission. And even like the way that my, my career has happened is I started off as a health educator in medically underserved communities, went on um, uh to do quality improvement because I saw in the communities like children serving as medical interpreters like all these different things. So I wanted to work on the systems level on quality. So I went to Kaiser to do that. And as I was like I worked in medical home care and as I was in home shadowing um for quality things noticed really low hanging fruit for innovation to impact greater change, for better quality on population. And um, went to Honor as an early stage employee to be more in the innovation ecosystem. Noticed that um, when I was at the startup that there were really the same types of people getting funding for their companies and they weren't the people who were oftentimes the populations that were being served. And so there were a lot of biases involved. And you know when we look at how homogenous the venture capital community is and how homogenous who gets funded is oftentimes it's a very. They look mirror like who gets funded, who the VCs are. And so um really became interested in funding more diverse companies and helping to support more diverse companies and went to venture capital as a result worked UM with 30amazing companies at Kaiser's venture fund um but really saw a pattern where uh, in scaling and these were like mid like they're series B series C's companies. But always there was um an issue of scale. Oftentimes always came back to a policy issue or industry misalignment issue. And so that's why I came to Blue Shield of California doing what I do now, um to work on some of that. And so it's like building blocks of a career and I don't think anything is random. And so like when you, I even like think about everything that I'm involved with right now. It's like I um, have been on the board for Family Caregiver alliance for years now and it's my time um as a health educator, as um you know working at Honor, working uh, in at Kaiser's ah, like national uh, Continuum of Care program where I really became passionate about the area and decided to become a board member there to help uh, with different. What are some of these resources that we can provide families who are going through one of the most critical painful moments in their lives sometimes. Right. Like, and so if you look at kind of all the things that I do, it has like it is, it happened because of what I've learned in my day to day work. Um, and I also think that one can have many lives and their career, their full career like you know, if hopefully knocking on wood, nothing terrible happens and you know we're in relatively good health and you know like we're gonna live to be pretty, pretty um, old hopefully quest figures. So uh, to. I don't think that gone are the days of. I am the subject matter of X and I worked in that X Field for 40 years and that's it. I think we all have a lot of passion. We all like have a lot of interest and I love the cross pollination of things too. Like you know, like what I learn, you know, in one area I can apply like, like very truly. Like things I learned from the amazing 30 portfolio companies that we had, like from their marketing departments of how they were marketing companies. Getting buzz and attention are, is incredible the things I learned because that's exactly what I'm applying to advocacy now and to move legislation. And so it's really cool to see that cross pollination. Um, um, so I would highly encourage others that might be listening. I actually got this advice early on um, in my career from um, he was the chief medical officer at the Health Plan for Quality at um, Kaiser Permanente. Um, and he was sort of like, yeah, make sure you don't have just affiliate yourself with one company or like one type of role or one whatever, you know, like have diverse interests and cultivate those things. Um, it will make your career more fulfilling and also it'll make you a better kind of candidate in general for other folks to engage with because you are, you have many feathers in your hat, so to speak.

Speaker A: I like that. So um, what are you most looking forward to for 2025? What are some changes or trends in healthcare that you're most excited to witness?

Speaker B: Yeah, um, honestly I am. I'm really looking forward to people actually fully understanding how it's the unsexy things that get the sexy things to move. Like I think that there's so much really incredible cool innovation and innovative things happening and it's like all this buzz around these tools and different things. But I do think that as people go out there to pitch more and more to health plans, provider groups and understanding the ecosystem or even like doing pilots and getting adopted and understanding some of the more crunchy, like not cool things that need to be for those things to work.

Speaker A: And again, so tangible.

Speaker B: Yeah, right. Like those crunchy things are like data sharing, payment models, financing of like integrated uh, behavioral health. Like these are, these are all like, some of those crunchy things are very important. So I am looking, um, not to sound repetitive, but I am looking forward to more players at the table and understanding how impactful and important this is. Like this is. There's so much happening in our ecosystem of general healthcare, healthcare innovation, healthcare transformation, like that, you know, if people may already be engaged, but I think people are going to start to become more and more engaged and having seats at the table trying to design the best possible supportive systems. Um, and so I'm looking forward to that. I'm looking forward to, I'm looking forward to every major health plan having an industry initiatives team where we all work together to really move this stuff, be more streamlined. I'm looking forward to there being so many different, like Connecting for Better Health is such an amazing case study of what we can make happen as far as, like when we come together as an industry, like create an organization, a coalition to advocate for a really huge, massive piece of um, legislation that like affects all of us and how that moves and how we work together. Like, I just think I want to see more connecting for better health. But like for all the things, like to create a digital health. Yes, for digital health, for all the things. I think it's already started. The movement's already started. It's just like going to continue to build.

Speaker A: Fantastic. Well, this has been amazing. Shruti, you absolutely crushed it. Um, thank you so much for the insights and words of wisdom. I have one surprise question for you. Um, who are one or two healthcare executives or people in the industry that you look up to that you like to like us to see? Interview next on the Front Door newsletter.

Speaker B: Have you interviewed Monica Soni yet?

Speaker A: We have not. We'd love to have Monica on.

Speaker B: Well, obviously Monica, I already talked to Mr. So many. I'm going to give more. Um, Susan Phillips is another one. She's amazing. She's at dhcs. Um, she, uh, uh, Paula Varia. I'm sorry I butchered the last name right now, but I'm just so excited to say all these names. Um, Sarita Mahante, if you haven't interviewed her. Um. Oh, my gosh. I'm like, there's so many. Like, so many. Atomica, Arthur. Um, Madame Medicaid is what they call her. Uh, have you interviewed any of these people, or.

Speaker A: No, I have not. I've not. I think, Monica, it would be fantastic. Um, Sarita is super relevant, especially with the session connection. So. Yeah, this is great. I will. You can write down this list and even.