Growing up, neither of us could have imagined that our lived experiences would resonate in our work in such a profound way.
One of us, Monica, a Harvard-educated physician leader, realized through her screening program for health-related social needs that she would have screened positive for housing insecurity while growing up. For Shruti, ensuring that her aging mother has consistent access to high-quality care while moving in and out of Medicaid eligibility has remained a challenge, despite Shruti having a deep understanding of the healthcare industry gained through her experiences working in roles across the healthcare ecosystem.
For both of us, these experiences expose that our nation’s healthcare system does not always account for the complex realities of individuals’ needs. It’s unexpected that a Harvard student would have profound housing insecurity, or that a healthcare leader’s family member would struggle to navigate the healthcare system due to income. Too often, we have preconceived notions about who might face challenges like health-related social needs and low health literacy.
However, as we have so keenly experienced, these issues are common and broadly felt. When our healthcare system has a limited understanding of who is affected, we not only fail to provide adequate services for people whose needs are going unidentified but also stigmatize the need for these services, further hindering the ability to connect people to care.
Our lived experiences reveal an opportunity to embrace a new approach to care that anticipates the unexpected and closes the gaps in our healthcare system that so many fall through. This change would require that we reconsider the foundations of our healthcare system, minimizing the artificial segmentation that underserves patients by failing to account for the complexity of their lives. In the meantime, we must take the initial steps toward this transformation, using tools like auto-enrollment, payment reform and data sharing, which can be powerful levers to drive change.
Like Shruti’s mother, thousands of Californians move between Medicaid and other types of coverage each year. Bureaucracy and barriers cause people to fall out of the system. Some health insurance marketplaces have begun to automatically enroll people when they lose eligibility for Medicaid to fix this issue. This approach recognizes that seamless, integrated experiences are what we all need and deserve.
Primary care plays a critical role in breaking down silos in our system of care by identifying unmet needs and connecting people to services, including for health-related social needs. To increase investment and strengthen our primary care system, select payers are embracing a modern approach to collaboration: co-opetition, in which competing entities collaborate to maximize impact to expand the benefit. These competing payers are currently aligning under a memorandum of understanding (MOU) to advance the California Advanced Primary Care Initiative, led by Purchaser Business Group on Health and the Integrated Health Care Association. Through this co-opetitive approach, these payers are able to do far more together than they could individually to strengthen and scale a primary care model that emphasizes comprehensive, person-focused care.
Data sharing is at the heart of building a more connected system of care. In California, the Data Exchange Framework, which facilitates the secure exchange of health and social services information, has been transformative in its role to ensure that healthcare and social service providers have the information they need to deliver coordinated, whole person care. To support its implementation, the Connecting for Better Health coalition has emerged.
Bringing together stakeholders including payers, providers, social service leaders and technology partners, Connecting for Better Health advocates for data-sharing policies, collaborates on best practices and supports the more than 3,500 entities that have now agreed to share patient information safely across the state on an unprecedented scale.
Healthcare is complex, presenting challenges even for those of us deeply connected to it. As individuals whose personal and family needs have been overlooked by traditional healthcare and social service systems, we look forward to a future in which healthcare’s foundational approach is purpose-built to be a more connected, holistic system of care.
Monica Soni, M.D., is chief medical officer of Covered California. Shruti Kothari is the director of industry initiatives at Blue Shield of California.
Editor's note: Covered California and Blue Shield of California are participants in the Purchaser Business Group of Health. Blue Shield of California is also a participant in Connecting for Better Health.