In August 2025, Blue Shield of California named Mike Stuart as its CEO.
Now, a year later, he's reflecting on months of work toward addressing affordability, member access and the patient journey. Stuart has been with the Blue Shield team since 2014, and previously served as its chief financial officer.
Taking the CEO role has allowed for "a different level of exposure" to Blue Shield's members, provider partners and employees. That perspective has served as a foundation for identifying where to push as the insurer looks to tackle healthcare's biggest challenges, Stuart said in an interview with Fierce Healthcare.
"I think it just helped me shape the vision and the direction of the organization, and more deeply understand what is important to our members," he said, "and in some cases, really understanding what is flawed with the system, and therefore what we need to focus on to get those flaws out."
The issue at the crux of healthcare is cost and affordability. Stuart said this trend is driven by two "colliding" factors—a healthcare system that's incredibly expensive on its own, and a population of increasingly sick patients.
Impacting the general cost within the system, Stuart said, is more immediately in reach for organizations like Blue Shield. For example, the insurer led the charge in rethinking pharmacy benefits through its Pharmacy Care Reimagined program, which unbundles key services from one pharmacy benefit manager and instead leans on multiple vendors to build a full suite.
The current cost of healthcare also underscores the broader shift toward value-based care, he said, as alternative payment models support improved health outcomes and better managed costs.
Making these shifts work requires a willingness to do "disruptive things," and then iterate and learn from what works in that transformation, said Stuart.
"I think being bold is what this country needs in terms of affordability right now," he said. "And I would much rather be in a position where those closest to the care, closest to the members and the patients, are the ones making those bold moves, versus something that maybe is more of a blunt force because people said there's no more money."
"I think working with pace and urgency to be more surgical but bold is what's really needed right now, and and that's what we're focused on," Stuart added.
The launch of Pharmacy Care Imagined has highlighted, for instance, the need to think differently about partnerships and building bridges with other stakeholders. Stuart said Blue Shield is bringing that thinking to provider relationships, in support of alternative payment strategies that can manage cost without diminishing outcomes.
The affordability crisis also emphasizes the need for more investment and focus on preventative care. Just shy of half (47%) of American adults have two or more chronic conditions, with many managing more than that, Stuart said.
That figure can't just simply be baked into the broader cost of care, he said, as the number of people with chronic conditions has continued to grow over the past several years. And while an aging population contributes to this trend, chronic conditions are on the rise among younger people, too.
"If you just project that generation forward, you have an ongoing cost issue if you don't address it," he said.
Stuart said that from the plan's perspective, both the growing disease burden and the cost of services must be addressed in tandem to reach true affordability.
As Blue Shield takes aim at affordability, digital tools and technology offer a significant opportunity to make a significant change. For instance, there are more than 400,000 members enrolled in its Virtual Blue plan, a virtual-first PPO that aims to integrate virtual options with in-person visits.
Another area of focus for the insurer as well as its parent company, Ascendiun, is establishing a digital health record that arms patients with critical data on their health and care experiences.
Blue Shield is building out digital records for its members, Stuart said. State regulations around data sharing have made that effort a bit easier within California, but the team believes a digital health record should be a priority nationwide.
"That's something we believe firmly every American should have," he said.