The Exec: Virk Details Clinical Product Iteration at Blue Shield of California

Dr. Pushwaz Virk describes how development, innovation, and integration intersect to support members and providers.

In this Q&A with HealthLeaders, Dr. Pushwaz Virk describes clinical innovation at Blue Shield of California, which serves 4.8 million members in individual and family, Medicare Advantage, Medicaid, and group employer plans across California.

HealthLeaders: Describe your roles at Blue Shield and how they support product development.

Dr. Pushwaz Virk: I come from a healthcare delivery background and was Chief Medical Information Officer at a health system in Northern California. I joined Blue Shield of California two years ago and, from a provider perspective, my initial focus was around financial transactions and billing. But as I learned over time, health insurance companies do a lot more — especially with the alignment of processes and incentives so that our members get what they need, faster. I still practice clinically to keep my hands on the pulse of how I can serve patients in my current role.

My role at Blue Shield is Medical Director of Clinical Product Development, Care Innovation & Technology Integration. Clinical Product Development can involve development of any feature or service that either stands alone or is part of an existing application, benefit, or a partnership. We call our work clinical products because we have a clinical focus and like to take a product development approach: from ideation and prototyping to small pilots and expanding to tangible outcomes.

Care Innovation means providing healthcare in a better way, which reflects new ideas and business models. Technology Integration reflects how interwoven technology has become into how healthcare is delivered, monitored, and evaluated.

HealthLeaders: What is an example of a clinical product at Blue Shield?

Dr. Virk: DispatchHealth.

[Note: Dispatch provides “in-home, same-day, high-touch care that is delivered by a team of trained medical professionals who can treat more than 40 health conditions, including conditions like respiratory infections, pneumonia, and chronic obstructive pulmonary disease.”]

Instead of the member having to go to urgent care — especially if they have transportation issues, if urgent care is closed, or it's late at night — they call the DispatchHealth helpline. They'll be connected with a triage nurse, who will assess the initial complaint, then the Dispatch team will send an equipped vehicle to the member’s home.

DispatchHealth is deployed in five counties (Los Angeles, Orange, San Diego and parts of Riverside and San Bernardino) and across all lines of business. Now that the product is more mature, we’ve recently handed it off to another team.

HealthLeaders: How do you decide when to shift a product from innovation to operations?

Dr. Virk: It starts with the core of how my team is structured. They are involved early in the innovation process, from ideation and conceptualization. We test a minimum viable product and collect feedback from members and providers. When a solution is mature enough, we turn it on for members. We address any product dependencies — regulatory, data, EMR integration, and technology partners. Once the operational infrastructure, framework, and resources are in place, we can then scale to all of Blue Shield and transition to the team that has the experts in that area.

HealthLeaders: What factors are common to all members that Blue Shield leverages to develop and scale products?

Dr. Virk: This is a challenge for anyone in healthcare. Blue Shield of California looks for impact: benefits for members and providers, across the lines of business. On the provider side, for example, if a solution depends on integration, we will address that differently with health systems compared to smaller medical practices. We try to define our target audience and users as narrowly as possible, then look for commonalities. These include infrastructure and logistics for providers and, for members, tech literacy demands, solution delivery, and unmet needs.

If we’re not able to capture 100% of intended members with a product, we try to start with a large enough group and then fine tune later.

HealthLeaders: How does tech serve patients best and in what areas can it be a hindrance?

Dr. Virk: COVID was a turning point for technology adoption in healthcare. People are much more open to using smartphones, smartwatches with sensors, and health status monitors. Telemedicine is providing better access and care distribution. Another positive development is having more up-to-date data, more patients involved in their care, and combining patient-sourced data with AI to facilitate its use.

The challenge is getting all member data into the providers’ hands. Interoperability has improved but is still difficult, especially as patients move [across providers and health plans].

HealthLeaders: What top three strategic priorities are your currently focused on?

Dr. Virk: One area is improving claims processing for providers — ensuring they are accurate, up to date, and their status is communicated quickly to members. We are early in the process of working with technology partners and medical groups here. Second, is a focus on integrated community provider partnerships to increase healthcare access. Finally, we’re looking at newer value-based care models that serve more clinical scenarios and more diverse providers, specialties, and procedures.

HealthLeaders: What advice would you give leaders in a similar role at other health plans?

Dr. Virk: Healthcare is changing rapidly with technology, and we are working more with consumers and technology innovators. It’s important to get a good understanding of DTC healthcare companies [direct-to-consumer], for example, that provide services like musculoskeletal and mental health care.

The expectations for providers and members are changing, and we need to get used to that change — addressing how they want to be served. All of us in healthcare serve the mission to keep our members healthy. We can’t work in isolation. We need to be aware of the innovations going on in the market and bring some of that inside the organizations.