Health Plan CEO Reveals Proven Strategies for Digital Health Innovation
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J. Bradley Wilson is CEO emeritus of Blue Cross Blue Shield North Carolina. After a successful career as a practicing attorney and service as General Counsel to former Governor James B. Hunt, Jr. Brad joined BCBSNC as General Counsel in 1996. During his 22 year career at Blue Cross Blue Shield North Carolina, he held four different senior executive positions until being named President and CEO in 2010. Under his leadership, Blue Cross Blue Shield North Carolina fully implemented the Affordable Care Act. In all, 100 North Carolina counties grew to 3.9 million customers and approximately $10 billion in revenue.
Top 3 Trends in Healthcare
Sohum: Looking back at 2023, what were your top 3 takeaways on the healthcare landscape?
Brad: The first one that comes to mind is that despite all of the energy and money and innovation and effort that everyone is putting into the improvement of health care – and particularly focused on the patient being the center of that universe – healthcare continues to remain complex, hard, confusing. And people continue to struggle to optimize. From that, I’ve distilled out the term, “interoperability”. That does not suggest just government compliance. It includes electronic medical records so that if I see three different physicians for three different reasons, they'll all have my chart when I walk in the door. Interoperability across the entire healthcare ecosystem is the key to quality, which includes the patient experience.
The next one is probably not a surprise: generative AI. It's been around for a good while, but since 2023 has been exploding. What does it mean? What are the limitations that we should put on it, if any? All of the issues and opportunities that a new technology like AI brings will remain center stage in 2024 and beyond.
The third thing that I’ve been hearing consistently is that the acceleration of the convergence of mental and physical health care delivery will continue. I believe that was highlighted, triggered and spawned by COVID. And then you combine that with the expansion and improvement of virtual and digital care resources: it’s hand in glove. Lots of innovation will continue and energy will be spent on how to optimize all that, because we're nowhere close yet. And in many ways, we don't even know what we don't know.
Future of Digital Health
Sohum: How has your view of digital health – like telehealth, apps, virtual first care, et cetera – changed over time, pre pandemic versus post pandemic? And looking at your crystal ball, what does the future hold in store?
Brad: Well, digital care is here to stay. Remember, my last tenure as CEO began in 2010. There was very little or no conversation about digital care in 2010. I was fortunate, along with my wonderful colleagues at Blue Cross Blue Shield North Carolina to watch that evolve during my tenure. And my goodness, how far we’ve come so that it’s now a centerpiece in a conversation like this.
I’ve already alluded to COVID: if there were benefits of that dramatic circumstance for our world, it certainly taught all of us that care delivery was going to have to be multidimensional. That was an accelerant, and so it is now embedded in the healthcare ecosystem and will continue to improve and evolve over time.
I've seen a great appetite for the use and deployment of digital care technology, but now there's a bit of a clutter as leaders in healthcare, on the mantle of trying to serve patients, adopted lots of one-off solutions. We are at a point where we may have too many digital health solutions on the market. As a healthcare CEO or chief medical officer, should we actually select? Which ones should we try to build on our own? Those are questions that are very present today.
Payer Digital Health Strategy
Sohum: How did digital health fit into North Carolina's long term mission? Were there any challenges you faced when determining your digital health strategy? What might you say to other decision makers and leaders at health plans on the importance of digital health?
Brad: As the technology evolved, our thinking and strategy evolved. You've heard the sports metaphor, you want to skate to where the puck is going, not where it is. We developed the appropriate intellectual capital, organized teams to be the thought leaders internally, to bring us the best of what's available in the marketplace.
Parallel with that is that you can't outrun your provider partners, and many of them were doing the same thing. There was a mutual education we engaged in to bring ourselves together about what would be optimal for our customers and their patients.
But the central point to all three of your questions is we recognized that it was going to be a catalyst for change, and it was important that we go to school on it and understand it. Don't be afraid of it. Yes, we had trials and we had errors, but that's how you learn.
Payer Innovation and Tech
Sohum: Blue Cross Blue Shield North Carolina has been deemed one of the most innovative health plans for several years now. During your time at North Carolina, how and why did you prioritize novel care strategies and technologies?
Brad: Think about when I was CEO. It was February 1st, 2010. The ACA (Affordable Care Act) was signed into law. It accelerated the revolution that was already underway in healthcare, it was catalytic. It created a sense of urgency that the world had changed. My predecessor positioned the company well. We were already in a ‘change’ mentality. So I became CEO with a wonderful team of people who embraced the fact that we were living in a different world. I would suggest that, yes, you’ve got to be good at tackling operations, but you have to have an environment welcoming to innovation.
Payer-Vendor Partnerships
Sohum: Many of the technologies you were focused on at Blue Cross North Carolina came from external partners or vendors. What did the typical process look like to work with them? And how should innovative companies approach plans today?
Brad: One of the things that I observed over my 22 years there was a tendency, at least within North Carolina and many other blues, that if there was something new, we had to build it ourselves. And we thought that was a requirement, otherwise it wouldn't be done right. And we had to get over that. It was a little harder than you might think, and that took a long time.
Embracing third party vendors should be part of your business strategy. So number one, recognize the benefit and the opportunity that the free market can bring to you. Number two, have a system and an organization by which you can identify, get to know, vet, and then make decisions. That's hard work.
And again, with all of the interest that there is in healthcare, there are plenty of shiny objects. So I advise clients as they’re working on their ideas, do not forget that requirement of materiality. If it's simply an incremental improvement, you're probably not going to be as attractive as the next opportunity.
The digestive tract of implementation is only so large. Strategic decisions are made about what five new projects will materially improve quality and lower costs for our customers. That's the mantra. You have to be able to demonstrate how your value proposition will materially impact those two components.
Payer-Vendor RFP Criteria
Sohum: What were the most important criteria North Carolina had when deciding to work with third party solutions, especially digital health ones? What are perhaps some of the prerequisites you suggest to any companies planning on selling to plants today?
Brad: It's always the question of how, if we deploy and become your partner, you are going to improve quality, period. You've got to be able to show that you move the needle in a material way, not just incrementally. And to be very clear on this ease of deployment and use, if you are a vendor talking to me and it's going to consume 50% of our available IT resources to integrate your solution into our environment, that's not a good place to be.
And last but not least, flexibility. Is your asset elastic enough that it can continue to evolve along with the opportunity or problem you're being asked to solve?
Cost, Quality, and Engagement
Sohum: What roles do cost savings, quality of care and member engagement play in a plan's motivation to onboard digital health and other health tech solutions? Out of those three cost savings, quality of care and member engagement, what is perhaps 1st, second and third?
Brad: Member engagement can be a freestanding, third component of the analysis. But a better way to think about member engagement is embedded in the other two. Because if we invest in a wonderful asset that could change people's lives and only 10% of our customer base is deploying it, well, your quality metrics are going to be less because you don't have a material amount of your customers engaged in it.
My advice to vendors would be to make sure you can speak to the material improvement your asset will make in member engagement. I can think right now of two or three things that we implemented that we were dissatisfied with. The percentage of member engagement, it was okay, but boy, if you'd gotten to a 70% engagement level—, you're changing the world then on quality, cost, and outcomes.
Point-Solution Fatigue
Sohum: The concept of point solution fatigue has been voiced consistently by other leaders like yourself. What approach was NC taking to address that? What novel approaches might you recommend to plans combating this problem today?
Brad: The catalog of opportunities was much thinner then, but we were vigilant and would deploy our usual discipline in value assessment on digital health solutions that were deploying and cycle back to the vendor and say this is not working like we thought. What can we do to make it better?
There are so many solutions now that have in fact been deployed. Let's take time now to be serious about the assessment of what we have, we being the industry. You'd rather use what you have and improve what you have than to drop something else new in that's just kind of the general thought process.
Innovation at Regional Payers
Sohum: North Carolina had a big impact on the other Blues plans and the industry in general. How might smaller state based or regional plans use innovative strategies to improve member engagement, satisfaction and trust? Especially when they might not have an institutional network or support that Blues plans have?
Brad: I would urge smaller organizations to not be bashful about leveraging. You must believe that it's necessary and proper and think about a way to do it. I've always found even in the competitive environment, most of your colleagues in that competitive environment more often than not are willing to give you advice and aid and comfort. The intellectual capital is available, but not if you don't ask the question.
Number two, stay actively engaged in the external healthcare environment. You just have to go to some conferences, you have to go to some college campuses that are always putting on seminars. Remember, once upon a time every organization was small and struggling and wanting to be bigger. So you got to stick to it.
And that’s about leadership, general leadership principles that are universally applicable whether you're in the healthcare business or the widget making business. I remember hearing Coach K of Duke respond to the question, “What is your job?” His answer was I'm a leader who happens to be a basketball coach. That's the way we should think about leadership.
Things like courage and vision, discipline, inspiration, empowerment, those types of terms can be applied anywhere. So if you're a small organization and you're the leader of it, you need to have those attributes and being small will not be a problem.
What’s Next in Healthcare 2024?
Sohum: What are you most looking forward to for the rest of 2024? What are some changes or trends in healthcare you're most excited to witness?
Brad: If you asked me to pick what I think will be the most exciting, certainly by definition the most challenging, but has the greatest long term potential, I would pick Generative AI. I have a lot to learn in that regard, watching and learning and observing the evolution of that particular asset, not just in healthcare, but across our entire society.
I have great confidence in the future because of the incredibly smart, visionary and creative people that I have the pleasure of either meeting or actually working with. It's going to get better. So I'm excited about the future of healthcare and as a consumer, I want it to get better sooner rather than later. Of course, as a wise person once said to me, we are all patients.
