Karen Xie, PhD, is the chief technology officer and senior vice president at Blue Shield of California, where she executes the $20 billion payer's technology strategy.
She spent much of her 20-year healthcare industry tenure on the provider side. Before she joined Blue Shield in 2014, Dr. Xie worked 16 years at Livonia, Mich.-based Trinity Health. She was also a research scientist in quantum physics at Columbia University in New York City. But to reach her ultimate goal — "to change the healthcare ecosystem" — Dr. Xie said she had to go beyond the provider world.
In a recent interview with Becker's, Dr. Xie spoke about the role she believes technology plays in healthcare, what Blue Shield is doing to address provider and member frustration, and how Blue Shield's new claims initiative aims to change healthcare consumerism.
Editor's note: Responses have been lightly edited for clarity and length.
Question: What is your philosophy on technology's potential to transform healthcare?
Dr. Karen Xie: Technology is truly an enabler for transforming healthcare. The healthcare system has pain points. To me, there are three fragmentations. Number one is siloed health data. It's generated by various health systems, within hospitals, clinics, lab systems and pharmacy systems. Health data is everywhere, but comprehensive health information is nowhere. The second fragmentation is disjointed care delivery across all settings. Whether it's transitioning to specialty care, ambulatory care, home care or optimal care — it's all disconnected. Third is the complex customer experience. Not just for members, but also providers.
Q: What are you doing at Blue Shield to address these fragmentations?
KX: At Blue Shield, we have a vision of a healthcare system that is worthy of our family and friends. Our mission is to ensure all Californians have access to high-quality care at an affordable price. So to achieve this, we really can't rely on incremental changes. We must transform the healthcare system, where care is based on each patient's medical history, their genomic profile, and their specific social determinants of health. Health plans also have to financially reward healthcare providers for optimizing health outcomes. All these solutions are increasingly high-tech and high-touch.
Q: Can you give me an example of what "high-tech and high-touch" means for patients?
KX: Blue Shield is investing in an independent nonprofit health information network organization. That company is called Manifest MedEx. It is uniquely positioned to provide a secure statewide health information technology platform for all Californians. Manifest MedEx unlocks community data from hospitals, clinics, lab systems and pharmacy systems, and integrates that data with claims data from payers. This will give healthcare organizations every bit of information they need to make healthcare decisions faster and more accurately. It's so significant that it can reduce preventable medical errors and unnecessary redundant tests.
One example is using data to ensure shared decision-making. Consider a cancer patient. If his or her genomic profile indicates that they're not a good candidate for chemotherapy, they can avoid this difficult treatment that won't offer any clinical benefit or outcome. This can also avoid a huge financial cost. Chemotherapy is not cheap. Why would a patient engage in this treatment if it won't offer clinical benefits?
Q: In late July, some of the largest players in healthcare — including Blue Shield of California — partnered on a new model aimed at making medical claims data easier to access for patients. How will the effort, called the CARIN Blue Button data model, transform care?
KX: Let me give you an example. I'm the caregiver for my dad. He's 93 years old. He had a stroke last year. And because there is no comprehensive health record on him, I have become his health record. Can you imagine what may have happened if I didn't mention medications, allergies and past medical history to his physicians when he was taken to the ER for his stroke? It's a life and death difference.
With CARIN's Implementation Guide for Blue Button initiative and our other projects, we're looking to share claims data to promote health data exchange, so I don't have to be my dad's personal chart. We're certainly not doing technology initiatives for technology's sake. As I mentioned, these are all truly needed. I only wish the entire ecosystem was more adoptive of the healthcare transformations we are doing today.
Q: What else is Blue Shield doing to advance healthcare through technology?
KX: We're starting an initiative to deliver a modern retail healthcare experience. We're developing a technology system that enables real-time end-to-end claims processing. Today, a physician has to complete an EHR update before coders can move forward with medical billing. The medical bill is required to process claims. How can you articulate patient liability in this process? Our real-time claims initiative aims to resolve this huge issue. Our goal is that a claim for a doctor's visit will be paid at the point of services, the same day. Not weeks or several months later. We're piloting this initiative with a provider that has a physician group and a hospital, as well as through partnerships with technology companies that are developing this system.