Q&A with Paul Markovich, President & CEO of Blue Shield of California

1. What are the most critical issues the healthcare delivery system must address to more effectively meet consumer needs?

The most critical issue we need to solve, above all else, is the health care affordability crisis. Fiscal and financial sustainability in health care won’t happen unless we control costs, which is largely dependent on partnerships between the public and private sectors and realigned incentives. 

In California, for example, a collaboration of labor groups, employers, providers, health plans, and consumer groups launched the Office of Health Care Affordability. This office is empowered by law to limit rising healthcare costs and acts as a forcing function for individual players to provide high-quality care in a sustainably affordable manner.

We also need to make healthcare engagement easier for consumers. From relentlessly focusing on the digital experience to continuing to refine care management programs and offerings according to consumer preferences, we need to meet and exceed expectations to deliver value.

2. You’ve said the healthcare system doesn’t just need to be improved, it must be reimagined. What are the biggest opportunity areas for “reimagination”?

We need to create a healthcare system that is not just consumer-oriented, but also worthy of our family and friends and sustainably affordable. We can’t do that until we bring health care into the digital age, better facilitate the shift to value-based care, and in many cases, completely reinvent deficient parts of the system, including the pharmacy value chain. The current pharmacy system thrives on complexity and opacity. It’s highly inflationary, without a lot of accountability for outcomes.  

What our country needs is a more transparent, value-based pharmacy model that gets health care consumers the medications they need at a substantially lower cost. Progressive partnerships that enable direct negotiations with drug manufacturers and reward for efficiency and affordability will be the way forward. 

We also need continued scrutiny at the federal level to help mold a fairer pharmacy system. 

3. How are big tech/healthcare partnerships facilitating industry transformation? 

High-value tech partnerships are key to health care’s reinvention. We can’t deliver the best treatments, tailored to individuals, or bring down administrative costs and burden, unless we simplify, digitize, and automate the environment we’re in. 

By working with tech partners to do things like create scalable infrastructures, launch engagement platforms, and make health information not just sharable but also actionable, we can meaningfully improve the notoriously painful parts of the system that have a direct impact on cost, quality and experience. 

4. What’s your bold move for health care in 2024? 

Certainly, our bold move of 2023 - breaking and rebuilding the pharmacy value chain through Pharmacy Care Reimagined – continues to be a huge focus in 2024. We continue to make progress toward our 2025 launch, laying the foundation to improve transparency, affordability and experience. 

This year, we’ll also have some exciting announcements in the coming months in other areas where we take on other major pain points in the system. Continuing the approach from Blue Shield of California where we don’t just make small changes or put a Band-Aid on the problem, we are going to fundamentally break down and rebuild the systems that aren’t working.