Unleashing Disruption in Healthcare: Guiding Principles for a Transformative Future

By Navi Mudahar, Director, Virtual Care, Blue Shield of California

In healthcare, where lives and well-being are at stake, the journey toward transformation demands audacity, innovation, and a willingness to challenge the status quo. As I engage in an executive education course “Building Power”, I’ve discovered a meaningful connection between the current drive to digitize healthcare and broader principles of power and disruption. This connection is illuminated by Malcolm Gladwell’s exploration of how David triumphs over Goliath – a tale that resonates with our mission to redefine healthcare delivery in our country. I’ll explore the fusion of these concepts and how they offer guiding principles for unleashing the full potential of disruption in healthcare.

The Power of Integrated Hybrid Care

Our path toward transforming healthcare is intertwined with the power of integrated hybrid care. In this landscape of disruption, the proliferation of point solutions and substantial VC investments in digital technologies have irrevocably altered the healthcare landscape. This influx of niche care models has prompted us to reevaluate the conventional healthcare model. And as stewards of membership premium dollars, we must recognize the paramount importance of scrutinizing the myriad of value propositions presented by these solutions. Our approach hinges on a meticulous consideration of factors such as interoperability, effective management of chronic conditions, efficient closure of care gaps, willingness to embrace value-based arrangements, and so much more.

The essence of health extends across multiple dimensions, and our care delivery system must accurately reflect this complexity. Yet, it is essential that our strategy for achieving this equilibrium ensures accessibility and ease of navigation. Healthcare’s evolution necessitates a harmonious blend of specialized point solutions and an overarching framework of integrated care delivery. In an era where healthcare transformation is propelled by technology and an abundance of point solutions, I find striking parallels to power dynamics. Specifically, two themes come to the fore, offering us a roadmap as we forge ahead to reshape healthcare delivery:

1) The Advantage of Rule-Makers

Gladwell’s observation that rules favor those who create them resonates deeply with our mission and is evidenced by the sheer volume of start-ups and innovations that proliferate the market. In healthcare’s digital age, we’re not just bystanders; we’re shaping the very rules that govern healthcare interactions and systems. By being at the forefront of innovation, we can  establish standards that prioritize patient well-being, enhance care coordination, and streamline processes. Furthermore, we have a responsibility to delicately integrate novel & niche healthcare solutions that deliver care in new modalities, whether synchronous, asynchronous, text-based, AI-based, or others.

The power to craft these rules is a catalyst for change. It allows us to discard outdated models that hinder accessibility and cost-effectiveness, and replace them with frameworks that promote digital solutions when and where appropriate.

2) Challenging the Status Quo

Gladwell’s assertion that breaking the rules can lead to extraordinary success underscores our mandate to disrupt conventional healthcare practices. Innovation demands a departure from the norm, a willingness to question established norms, and the courage to tread uncharted territories.

More specifically, in digital health, challenging the status quo involves breaking free from the limitations of brick-and-mortar settings and embracing the potential of hybrid models. It involves:

• Co-developing hybrid models of care that integrate virtual and in-person
• Open dialogue with regulators that create space for disruption
• Harnessing seamless bi-directional clinical health data exchange
• Building systems that harness data analytics and AI to guide diagnoses and treatment plans
• And openness to value-based payment arrangements that reward quality and reduce cost

Through this disruption, we unearth new pathways that enhance patient outcomes, foster effective preventive care, and lay the foundation for a healthier society. 

Embracing the power of integrated hybrid care and digital innovation positions us as architects of change.

Shaping a Transformative Future

As the Director of Virtual Care at a non-profit health plan, I am privileged to be positioned at the forefront of disruption and innovation. Our recent introduction of a Virtual-Forward health plan product serves as a litmus test for integrated and hybridized care delivery. This product is integrated with our existing in-person PPO network, offering members an expanded spectrum of choices. It introduces a layer of team-based virtual advanced primary care, integrated behavioral health services, and access to 20 virtual specialties. Without a vertically integrated closed system model, our approach has been made possible through strategic partnerships and dedicated digital investments with a focus on seamless user experience and interoperability.

This journey has been punctuated by insightful deliberations with regulatory agencies, and this co-development between disruptors and regulators will continue to be pivotal in enabling us to chart a viable path forward. Yet, the fundamental question we pose remains under scrutiny: Can this paradigm effectively curtail healthcare costs while delivering superior member experience and high-quality outcomes? The answer to this question will guide our ongoing evaluation of virtual solutions, including Virtual Blue, and pushing us to iterate as we forge ahead. As we evaluate, we are continuously conceiving novel models that can position virtual care as an indispensable cornerstone within the healthcare ecosystem. We emphasize seamlessly integrating all facets, fostering interoperability, harnessing data-driven decision-making, enhancing member experiences, ensuring access, and upholding exceptional quality standards.

The landscape we navigate demands pioneering spirits and innovative minds. In our pursuit of a redefined healthcare paradigm, we recognize that the quest for optimized care delivery is not only transformative but also intertwined with the careful calibration of diverse elements.

Embracing the power of integrated hybrid care and harnessing digital innovation positions us as architects of change. By fusing the wisdom of Gladwell’s insights with our ambitions, we propel healthcare into a new era, where disruptions are positive catalysts for progress. Together, we are rewriting the narrative of healthcare delivery, ensuring that patients receive the quality, accessibility, and personalized attention they deserve.