Healthcare Innovation: From your bio I saw that before working at Blue Shield of California, you worked at Providence and then founded a company called Trusana. Could you talk a little about that? 

Shah: During the pandemic, we were looking at behavioral health needs skyrocketing, and Providence had a ton of primary care and other doctors where the need was acute and the access was limited, so we started Trusana, and it scaled pretty quickly. The idea was to create a 100% virtual behavioral health company that can scale fast, with providers with credentials that operate across multiple states. So I was convinced about the power of virtual care programs and how fast they can improve access across the care spectrum. As I joined Blue Shield, it was on my mind — how do we take learnings from Trusana and apply them? Blue Shield had recently launched a Virtual Blue Health Plan. We have lots of different plans, and it's one of the plans. The idea was a virtual first plan, $0 copay for a bunch of things. I thought this is a perfect container. But if it's just a plan, it's going to be restricted to the number of members who take the plan. So why don't we take the benefit, the core feature of the plan, and spread it across as many plans as we can? Let's take this plan and make it a platform that powers a variety of plans.

HCI: Were there some other lessons learned from your time at Trusana that could be applied to Virtual Blue? 

Shah: I learned a few things that we have been applying. One I would say is the power of technology in easing both the members’ but also the providers’ experience. That's huge. It allows you to take some of the mundane administrative tasks off of experts who would rather spend time taking care of patients. The second is using virtual care as like connective tissue, and that's how it's designed for us. So I equate it to an operating system. Your operating system runs in the background and powers multiple applications, and it connects the dots between them. That's how we've designed this. Your primary care, specialist, behavioral health, urgent care —  all these things go through the Virtual Blue program right now, and the system has to be designed as a connective tissue. So when the member goes from virtual to in-person, it's seamless. That was the other thing I learned at Trusana — that when we design these virtual programs, the seamlessness to in-person has to be there. Otherwise, if the handoff is not great, then you get a virtual experience and an in-person, and they're not talking to each other.

The other thing is that this has huge potential to drive affordability and access while actually delivering equal or higher satisfaction scores. Virtual Blue, provides satisfaction scores of 90-plus percent. We want to see that  it's not just reducing cost and making access faster, but it's also driving affordability.

Another thing I learned was that mental health and physical health have such strong correlation. Multiple data points and studies have proven that. So when you help someone who needs support with behavioral health, you see their medical costs also going down, and their medication adherence improving. So one of the things in the Virtual Blue platform we were pretty clear on is the importance of behavioral health screening. When you look at the data, 85% or more of the virtual primary care visits have behavioral health screening included.

HCI: Could you talk about what you’ve seen in terms of how Virtual Blue is affecting utilization, cost and access? Was any of it surprising to you? 

Shah: Not surprising. But we did not want to scale too fast without actually seeing the proof points. The average primary care wait is one day or less through this model versus many days in the in-person model. For specialists, it is less than three days vs. 15 to 20 days. So as we started seeing these numbers come through, the confidence grew that we had to scale this thing faster and put it in more plans. It saves 7 to 10% on the total cost of care and get people to see a provider faster. We're not surprised by the numbers, and I think the numbers are actually going to continue to get better as the platform adoption gets stronger. 

HCI: Is it easy to connect the dots between virtual care access and  improvement on total cost of care?

Shah: Yes, it cuts down on urgent care and emergency care. It’s a Friday night at 8 o'clock and you have a fever and you think should I go to urgent care? Now you can just get on a call and and get guidance right now? So we're seeing that as a big driver.

Also, almost three out of four members who are using this platform have one or more chronic conditions. There are people who need more guided care from specialists, but in-person specialist appointments are harder to get.

HCI: Is Blue Shield also working on AI chatbot-type features to answer questions or help triage where people should should go for care? 

Shah: We're building something for all members. When we say 400,000-plus members will be on the Virtual Blue platform next year, it doesn't include another 5.5 million members that Blue Shield has. So what we are building there is something that benefits all the members, and it is in the works.

HCI: Let me ask you about a few other Blue Shield initiatives I've read about. One I saw recently was Zocdoc integration. Could you talk about the value of that?

Shah: I think it was in 2024 when we started discussions with Zocdoc. We know we have thousands of members daily who come to our website looking, for a doctor. Find-a-doctor is one of the most-used features on the website. If all we do is provide you a provider directory, which is like dozens and dozens of pages of provider names and phone numbers, that's a job half-done, right? Because now you have to pick up the phone and start calling. Why don't we just close the loop in the moment? So I asked the team: why don't we just give these people appointments in the find-a-doctor experience? What if the providers offered appointment booking in our portal that is synced live?

We looked at the options. Should we build this thing ourselves or should we partner with somebody? Well Zocdoc has been building these pipelines into provider appointment systems for almost 20 years now, so it was a no-brainer. Instead of building separate different pipes into hundreds of different EMR systems, we thought why don't we just connect with Zocdoc, and they've been great partners.

We've been growing. I think we crossed more than 2 million appointment hours in the rolling 90 days forward window now. We have more than 20,000 providers, and we have thousands of appointments being made on the platform through our website, with pretty high satisfaction and a lot of repeat users, so I know that it's working. 

HCI: Another innovation I read about was a price check tool, so that you can get transparency on prescription prices and options…

Shah: When we look at the member experience, we have to ask are we creating friction or ease in that moment? One of the moments of truth that can be avoided is that pharmacy counter surprise of how much a prescription costs and what options you have. Is there a generic option?  This should not happen at the counter. This should have been solved earlier in the journey. With our Price Check My Rx tool, you are with your doctor who is prescribing a medication. You get a message on your phone saying, "Hey, you got this drug prescribed, and you have options.” You look at the options in the app, and your doctor is still in the e-prescribing system. You could say, can I get this generic? And by the way, could I get it at this other pharmacy, not my standard one, because I could save quite a bit of money. And the provider says sure. 

That was the whole idea of being proactive and giving the information where it actually matters.

HCI: The last one I wanted to ask about is the idea of a member health record that has claims data but also pulls together clinical data from provider organizations. Is that happening?  

Shah: It's happening. It started with the vision of our former CEO Paul Markovich, who is now the CEO of the Ascendium family of companies, which includes Blue Shield. He thought why can't we have all of our healthcare data in one place? In my case, my primary doctor and my specialist happen to be with two different health systems, and my dentist is not part of any health system, and my ophthalmologist is somewhere else. They all use different EMR systems, and different portals, and they're not talking to each other. I had to stitch together in my head all this data and create a record for myself. What if I didn’t have to do that? What if I just have a place where I can go and see all my longitudinal history in one place? 

So that was the idea. Let us give one place where members can come and see all of their health history from primary care, specialists, lab, imaging, pharmacy, dentist, and vision. That’s a very heavily utilized feature and we are using the app to help members stay on track with their health. Now we have what we call “member journeys,” where if you're falling behind on a care gap that you should have addressed, you get a message saying, "Hey, let's talk about this. We have a provider or a nurse who would like to talk to you about this, or we can help you schedule a mammogram that you're falling behind on.”