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The Exec: Blue Shield's Kothari on Co-opetition and Intersectionality

Analysis  |  By Laura Beerman  
   January 26, 2024

"We can't be competitors for a lot of this work to move," says Kothari, adding: "If you want to make change, you have to have a seat at the table."

An educator, community organizer, and startup innovator, Shruti Kothari never thought she’d work for a health plan. Today, she can’t say enough about her current employer, Blue Shield of California, and its unique transformation model. As director of Industry Initiatives, Kothari advocates for “co-opetition,” an increasingly collaborative and outward-looking approach by traditional competitors such as health plans

“We could all do more if everyone operated the way we do, with a focus on co-opetition.”

A look inside the Blue Shield model

Kothari states that Blue Shield’s Industry Initiatives is unique, from its funding to its operations. Created by president and CEO Paul Markovich and sponsored by EVP of Transformation Peter Long (HLM story), Industry Initiatives sits in Blue Shield’s Government Affairs division and partners across operational business units to navigate policy if/thens.

Blue Shield allocates separate funding and resources for Industry Initiatives. The team’s focus is improving access, quality, and equity in the healthcare system by advancing key issues including data sharing and payment innovation.

“The design of this is important because bandwidth is often limited, both in dollars and people” says Kothari. “It’s a big deal that the idea started with the CEO and had the support of other senior leaders. Our leadership team has continued to prioritize fostering industry collaboration.”

“Innovation teams are now standard at health plans; that’s not new. But if the ecosystem isn’t formed in a way that helps scale products, services, and technology, it won’t work.”

That ecosystem, as defined by Blue Shield, must include co-opetition and treat healthcare “as one word and two.”

“Healthcare is so fragmented and there are misaligned incentives. My team is really unique in that it's very specifically focused on this problem,” says Kothari. “We’re not competitors when it comes to modernizing healthcare so that patients, families, providers — everybody — can benefit.”

She adds: “More health plans should be leaning into creating a team like this.”

Proof points in payment innovation, data sharing

Kothari notes that Industry Initiatives “has had really good success backed by data on policy barriers and industry misalignment.” Blue Shield president and CEO presented examples at this month’s J.P. Morgan Healthcare Conference. Kothari and Blue Shield representatives provided additional detail, including:

  • Payment innovation: The Advanced Primary Care Memorandum of Understanding (MOU). The goal is to build a sustainable future for primary care through multi-payer alignment and increased investment aiming to address decades of inadequate resourcing and perverse incentives for primary care in the U.S. healthcare system.

Six health plans signed a MOU making public commitments to achieve this goal and support small and independent practices with transformation resources. Up to 30 practices will participate in a pilot program. Participating health plans will use a common set of incentives, investments, and resources to facilitate delivery of advanced primary care that is high-quality, equitable, and comprehensive.

  • Data sharing: Statewide data exchange. The goal is to support modernizing California’s health data sharing infrastructure by supporting implementation of a robust statewide data exchange that enables the timely sharing and utilization of health and social data.

Blue Shield has broadened the network of industry stakeholders invested in data sharing and real-time health electronic health records, including helping to build the non-profit Connecting for Better Health.

To achieve these goals, Blue Shield “takes risk at a different level for progression” says Kothari.

“We are committed to shaking up the status quo in healthcare. Being first to market with a payment model intended to invest in primary care is one example of that. We believe it's a risk worth taking, and that it will produce better quality and lower cost care.”

“But being first to market with any model as fundamentally different as ours is not guaranteed to be successful,” she adds.

“You can be at the intersection of a lot of things and still be a leader”

Kothari knows healthcare transformation. An educator and community mobilizer, she has been recognized by Business Insiders 30 under 40 and is founder of Women of Community, an organization committed to placing more Women of Color in healthcare leadership. Kothari is co-founder of the start-up Crown Society and has worked in venture capital.

In all these circles, Kothari knows what it feels like when you don’t look like anyone else. In addition, both of her grandmothers and her mother were in arranged marriages. The intersectionality of race, gender, class, and other areas is important to her.

“I know the feeling of being the marginalized person at the intersection of a lot of different things,” says Kothari. Growing up in rural America in Wisconsin as a daughter of immigrants, having seen the women in my family and what a privilege it is to have the freedom to go to school, go get a career, reach a different city, and try a new job.”

But there are still too few examples. Kothari cites a McKinsey report noting that 28% of the healthcare C-suite are white women, while only 4% are women of color (2022 data).

“Women of color don’t even put themselves up for leadership roles because they don’t see themselves in other leaders, because of intersectionality, because of all of the other responsibilities they are managing — including at home — and because of imposter syndrome.”

She has seen the same in the venture world.

“That’s where I started to see the dynamics of who gets funded and who doesn’t. Do you look like me? Have you had the same experiences as me? Then I trust you and I'm going to give you money to fund your company. The people who are getting left out are the people like me —people of color, women of color, even just women in general.”

But things are changing.

“There's been a movement to increase funding with us, which has been amazing,” says Kothari. “If you want to make change, you have to have a seat at the table.”

Laura Beerman is a contributing writer for HealthLeaders.


  • Healthcare transformation advocate Shruti Kothari serves as director Blue Shield of California’s Industry Initiatives.
  • In that role, she promotes two key principles: “co-opetition” and healthcare as one word and two.
  • Kothari leads at intersectionality’s flashpoints and in an industry with few female executives of color.

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