Shruti Kothari: You can't see what you don't know and no amount of research is going to make you actually feel those pain points. And guess what? You're not like the rest of the world like the majority of populations out there and so if you're trying to build and solve for an issue that does affect you greater populations,you need more people like that at the table.
Meg Escobosa: Welcome to the Game-Changing Women of Healthcare, featuring exceptional women making an impact in healthcare today. Together, we dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers.
I'm Meg Escobosa. Join me in conversation with some of the many brilliant and courageous women on the front lines of the future of health.
Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. A quick note before we get into today's episode, we are currently looking for sponsors for the podcast. If supporting and encouraging female leadership in healthcare is important to you or your organization, help us do that by becoming a sponsor of the Game-Changing Women of Healthcare, reach our engaged audience with a mention by me in future episodes, or we'll produce a short audio spot for your organization. At The Krinsky Company, we believe in female and diverse leadership in healthcare. If that's important to you too, become a sponsor of the podcast and proudly share your values with the world. Reach out to us at podcast@thekrinskyco.com and thank you.
Meg Escobosa: Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. Today on the show, we have Shruti Kothari, who is the
Director of Industry Initiatives at Blue Shield of California. She is an advocate for equitable healthcare transformation, leveraging her experience in health education, community mobilization, quality improvement, early stage startups, and in venture capital.
She is passionate about creating meaningful healthcare experiences for patients, families and providers. We are so thrilled to have you. Welcome to the show, Shruti.
Shruti Kothari: Thank you, Meg. It's an honor to be here. Thank you for having me.
Meg Escobosa: So you're leading Blue Shield of California's healthcare agenda, helping to celebrate this transformation of the healthcare system. And I know your aims are to make it universal, equitable, affordable, high quality, comprehensive, digital, simple, and sustainable, which are amazing qualities. How are you going about it? And what do you believe are some of the enabling factors? And have you encountered any resistance?
Shruti Kothari: Yeah. Super easy to do, right? All those things that you mentioned, I don't know why anybody else in healthcare hasn't figured it out yet. Yeah, so I lead a group called Industry Initiatives for Blue Shield of California. And what this concept basically is, is that all of us in the ecosystem, I think it's rare for someone to get into healthcare to not have some sort of mission orientation.
So all of us want all the things that you just said in the ecosystem and whether you're a provider, health plan, advocacy group, whatever, that is your ultimate goal. But when we think about it, we create these transformation agendas, these reform agendas, these innovation agendas, and we have these goals associated with them, and we pilot and test changes and they can either be vendor-related or process-related, the whole spectrum of things, and then when a pilot has success and we want to scale it, that's actually one of the hardest things. It is, how do you scale that? And some of the reasons for why it's so hard is that our ecosystem is misaligned, there's fragmentation. We have for, I mean, I'm even going to say as bold to say centuries, been, making workarounds and different things. And so as a result, it becomes very hard to scale without co-opetition and collaboration. And so that is what the whole premise of industry initiatives is.
If we want health reform and we want healthcare transformation, we need to collaborate with one another in the ecosystem and we need to co-opetate with folks who might traditionally be our competitors. So to your question, what we are trying to do is at Blue Shield of California, our healthcare transformation agenda: where have we piloted and tested and have seen really substantial evidence, that's positive, coming out of this of it related to equity, access, equality, all the things. But there are specific policy or industry barriers preventing the scale of those things.
Meg Escobosa: And can you elaborate on what some of those policy barriers are and maybe listeners who are part of this ecosystem have ideas about how to address that.
Shruti Kothari: Yeah, the areas that we are focused on for industry initiatives is payment innovation, and very specifically, advanced payment models in primary care. Data sharing and when we look at that, looking at a health information exchange that's universal, with all the players in the ecosystem. And then third is integrated behavioral health and so looking at collaborative care models and how they integrate both with finance and so on in primary care.
Meg Escobosa: Great. Well, I know that there is the effort to establish a healthcare information exchange in California.
Shruti Kothari: Yes.
Meg Escobosa: That has hit some barriers in the past and now we're at a new juncture and there's new effort to create.
Shruti Kothari: Yeah, yeah, absolutely.
Meg Escobosa: Are you part of that effort? Are you part of the ecosystem? Okay, very cool.
Shruti Kothari: Yeah, so for the data-sharing work for folks that may not know, for over 20 years, we have been trying to get a data-sharing health information exchange mandate placed in the state of California. But because again of misaligned incentives it just hasn't happened. And the pandemic was actually a really crucial moment where we saw other states who do have a HIE infrastructure really have amazing outcomes utilizing that with vaccination rollouts, with tracking, with lots of different things.
And so it was ripe in, around at the end of 2020 to really go hard and try to get policy passed. So Blue Shield of California industry initiatives, we were able to essentially start a coalition and move something. And so, Blue Path Health is the folks that we chose to start that coalition today.
I'm just going to fast forward. It was really hard, but that coalition is a standalone organization, a nonprofit with multiple funders, has thousands of organizations across the ecosystem and healthcare who are participating. And we did get legislation passed in 2021, which is again, over 20 years, people have been trying to do this and continue to advocate for amendments and things like that to make it more operational.
Meg Escobosa: Congratulations. That's a huge accomplishment given the history. I love the example that you gave about being able to tie, you know, using health data, integrated health data to improve vaccine rollouts and just have awareness of people, you know, how big, how many, I guess, citizens, community members have gotten access to care.
Is that the holy grail? What is the ultimate benefit of bringing all this data together?
Shruti Kothari: For you as a patient, if you get seen in an ED, That is not like your ED that you, you know, like in-network or something just because it's an emergency and that happens and then you have to go to your primary care provider who might be in a different network.
Right now, it's very challenging to share those records with this, it would be seamless in that way, right? There'd be one health information exchange where everyone who is a qualified provider and you yourself can access your information, regardless.
Meg Escobosa: Yeah, amazing. Very cool. So in terms of the, so the policy barriers and what were some of the other barriers, are there other barriers we should be aware of that we can tackle?
Shruti Kothari: Industry barriers are pretty huge in our ecosystem. And so, our payment work really is a great example of that. So what our payment work is, is we've all heard value-based payment models, right?
Like it is the buzziest, like let's throw this out. And so everyone talks about how it's wonderful and how it is a wave of the future and how we need to be doing it. Blue Shield of California was the only health plan actually testing value-based payment models. And so we got to a point where we had great outcomes, our providers that we were testing with were positive. Everyone was positive. The challenge is when you look to larger provider groups and they contract with multiple health plans, you can't change your internal processes, how you contract, all the different things for one health plan. You got to get all the health plans on the board to do this. And so it was ripe for an industry initiative sort of area to focus on because we were at that stage. Now, health plans aren't they're not best friends.
Meg Escobosa: Right? Exactly.
Shruti Kothari: Nationally speaking, but that's not what we are, our concept is based off of, and so we try to actually facilitate some of these conversations ourselves early days, but I get it. I wouldn't, why would you trust your person that's been a competitor for years and years, right? And so we realized this is a much bigger collaborative effort. So we worked with Integrated Healthcare Association, PBGH’s California Quality Collaborative to get several health plans at the table to talk about this, like, “Great, let's talk about value-based payment models and how do we actually execute this in reality?”
These discussions really took almost two years to get to the point of we now have a public MOU out and are now in the stage of actually piloting with a total of four health plans. And so that's, that's huge. That's groundbreaking. And so like an industry example.
Meg Escobosa: That's great. Do you have any secrets for how to get people to the table to have this conversation where the are kind of skills that you relied on that encourage people to the table?
Shruti Kothari: And I'm going to take one step back before I say this because industry initiatives - I don't know of any other health plan that has a team like this as truly forward leaning and innovative and looking progressively.
Meg Escobosa: Yeah. Where did it come from? This industry initiatives team.
Shruti Kothari: So this came from our CEO, Paul Markovich, and our Executive Vice President of Transformation, Peter Long. So two of the senior most people in our organization. It's an idea that they had, and so they had buy-in. Peter Long is our executive sponsor. He helps us with all of our strategy. So these folks, there is executive buy in top visibility. There are resources allocated to this work. There's teams. There's dollars to do things. And in health care, I mean, how many of us have heard of a really cool, buzzy job, and when you dig in a little further, there's no funding, there's no resources. You know, and so this in concept is amazing, but you need the resources to do it and we have it. So one, that's how it got started and it was foundationally set up really properly in order to execute on the work in a real way and then second the secret sauce, kind of, is realizing our place as a health plan and we want to collaborate and have co-opetition, but are we the most trustworthy source like to go to a competitor and say, “Hey, partner with us and whatever, even though we have the best of intentions,” probably not.
So the secret sauce is actually finding a third party that is neutral and has trust from everyone in the ecosystem and also has that same mission and vision, and to partner with them. So for our payment work, it really is, we could not have done this without Integrated Healthcare Association and that California Quality Collaborative group at all.
Meg Escobosa: That's awesome. Great to recognize that. And so who are, would you mind naming some of the other health plans that are involved?
Shruti Kothari: Yeah. So the folks that are on the public MOU and have committed to allocating resources and piloting for the advanced primary care work is us with Aetna, HealthNet, and Elevance.
Meg Escobosa: Fabulous. I'd love to dig into alternative payment models or new payment models besides. the concept of value based care where you pay an upfront amount, this is the amount we're going to pay you per patient, take care of them with these resources, and if you save money, great. And if you need more money, sorry, you know, that's your loss, providers. What are you trying that's new beyond that? Is there some other ideas on the table?
Shruti Kothari: Yeah. So actually this is a great distinction so oftentimes this work that I'm mentioning relies on the operational business units within a health plan, right?
Like you, you took it on, you piloted, you tested, and now you get it to scale. That's so much work, right? So we are not the group that is the operational business unit owners. We have a fabulous relationship with our executives and leads in those groups. But what we are is we're to support them to help scale that.
And so, there are things that they are doing outside of this, but for us, where we swoop in is like, okay, it's ready for scale. Great. And, so our SMEs, our business folks, let's go in and let's help them. And this is a partnership with them in order to scale this amazing work we're trying to scale.
And for us at Industry Initiatives, it is really focused on this with the advanced paid models, and I also say this because if there are folks listening who are like, “Oh, this is a great idea. We want to start this in our organization, and da da da,” we're now in year four of this program and we had some amazing wins, and so there's a lot of energy around trying to partner on projects. And we have realized there is a recipe of success for what a good program to take on and scale. And one of those components is a really strong business unit with partners who can partner with us, externally, to move these things.
Meg Escobosa: Very good. Okay. Let's talk about scaling because you worked at Kaiser Ventures. Was a big part of that, figuring out how to scale or the potential for scale for a new concept. Talk to us about that. What are your insights about what it takes to scale?
Shruti Kothari: So yes. So Kaiser Permanente's venture group, I was our first ever lead for strategic engagement, and what that basically meant is it was my job to know all of our portfolio companies, help them with their product development and business strategy and to think through, you know, if they were not Kaiser Permanente already, like to get those insights to help them. And then also if they were already implemented within KP in some way, how do we scale that through different regions and so on, and or make sure that partnership is continuing to evolve with our business of Kaiser Permanente. There are so many learnings and my background too, is I was an early stage startup implementer. I was one of the first employees at Honor, and then also before that have led national quality programs at Kaiser Permanente.
And so, I have this unique perspective of the system sides as well as being a frontline operator at a startup. And I think a death trap for so many smaller stage companies is that they see the business of something like a Kaiser Permanente or like a big organization of like, “Oh my God, if we just get this contract,” right?
Oh man. So many small companies have smaller stage companies have gone to die on that road because it's right. It's like it is. One of the biggest things I will tell companies is to sniff out if there's actually a there there. There are a lot of priorities in healthcare. Very few are funded, basically.
Now, we can say, That was one of my big jobs in that role was, okay, great. This is on our agenda of what our top priorities. Let me go talk to all the regional health plan leaders, all the regional medical group leaders, because they can have different perspectives than national leaders and see if there's actually funding to do this work.
And if we're even partnering externally for this work or building internally.
Meg Escobosa: And presumably that there is the step even before that, which is to say,” Is this need a priority that this solution is solving. This solution addresses this problem.” Is that important to you? And then on top of that, is there funding?
Shruti Kothari: And also another key thing to look out for is what is the road map? What is the internal roadmap for goals? Is it like a one year thing? Then it's a little questionable of like, are, there not going to be resources past year or two. What's happening? And so, there's just this investigative work to be done to uncover.
I think people take too many things at face value and healthcare of like, “Oh, but there was this big article about how we're now focusing on, you know”, I'm making a silly example, “giving dogs to every member that comes into their door. And it's like, okay, that's great that there was a big public announcement made, but is that real? Let's dig in a little further.
And so my best advice coming from that role to companies who might not have a navigator, like me within the ecosystem to help is oftentimes, when people get a meeting with somebody within that company, it's sales pitch, sales pitch, sales pitch. One, you might not be talking to the right leader who can make that decision. Who's making a decision. We all know that burnout of like when you email somebody and you'll get no response back. It's probably because they don't make vendor decisions and just don't have time to have a conversation with you.
And your email is very strong on sale. Use it as an example to get to know whether that is a top priority for that organization, whether they have funding, whether they're the right lead, build a rapport so they might introduce you to the right lead. If they're not that right lead, it's very, very simple things, but I think you're looking at it more as an investigator than a seller.
Meg Escobosa: You know, I was thinking about the fact that you've got this amazing diverse experience. Oftentimes, you know, looking back on your career, you can see the path, how you got to where you are, and that all makes sense, but even in your case, given your role at a health plan, how different is this view from the others and how much does your prior experience inform what you're doing now?
Shruti Kothari: Yeah. Oh my gosh, this is such a, this is a very interesting question for me because I never thought I'd work for a health plan.
Meg Escobosa: Right like out there first working with patients health education.
Shruti Kothari: Totally.
Meg Escobosa: Mobilizing community
Shruti Kothari: Absolutely, like this is a real thing. So, I started my career as a health educator in vulnerable communities for the American Cancer Society. And I will say that the way my career has worked is because of my mission of creating that transformation.
So, you know, as a health educator, it was like great direct one-on-one impact in the communities. But as I was out there, I was really seeing that there's a lot of issues and challenges. Within the systems, like the quality of things and using children as medical interpreters and, all these different.
Meg Escobosa: Yes.
Shruti Kothari: Right? And so then I was like, “Okay, great. Well, I'm going to go get an MPH and I'm going to go work at a systems level and improve quality and care experience,” and that's what I did. And then I went to Kaiser Permanente and I became their national lead for, it was at the onset of public reporting for medical home care.
So I, and I say this because I was quite young. I was in my mid-twenties and It was during a time when it was so inpatient-focused, that they were like, “Oh, like we even have a medical home care program? I didn't even know,” a sort of thing. Okay. Well, let's just hire somebody to kind of work on it.
And so I had this big role without people even realizing it when I came in as my first job out of grad school, it was at the onsite public reporting. It was the national quality lead for medical home health, hospice, and home based palliative care. It grew over the years of the course of like four years, but it started with medical home care.
And I say this because I think sometimes people chase the shiny star. That time that I went into that was not a shiny star. It was like, “What is even home care? What is that?” But in that time it became the buzziest thing. That's where care was moving. And so, doing that work, I just saw there were so many low hanging fruit in that space around innovation and technology so when it did become buzzy, and I had the opportunity to join a very well-funded startup. So for Honor, the startup that I had joined, they had just it was like four or five people, and they just raised $20M. And Marc Andreessen sat on the board of the company, which is a very rare thing.
And so, but they had been quoted in some things around home care and things like that. And it just worked out organically for me. It wasn't a part of the career.
Meg Escobosa: You were like the necessary expert on the team.
Shruti Kothari: Exactly.
Meg Escobosa: Industry expert.
Shruti Kothari: Exactly, and going from big company like that to small and doing all the things was like, one day, maybe I'm finding office space for us and one day, you know, I'm like, just like leading these programs and hiring your caregivers and all these different things. It was a wild experience. But what I learned from that is that there's such a disconnect because Honor has probably pivoted several times since that and what they deliver.
And I was one of the only healthcare people early days until I would say a full year into, and that's a long time for early-stage startup until they started having more healthcare-type of people. And it was really challenging at times. And anyone who's been at a company like this probably knows this, where there are more people who maybe are coming from the tech world and not the healthcare world, where there's simple things that you have to justify, like, for example, having a phone number to call for home care instead of it just being an app. We in healthcare think, “Oh, obvious.
Meg Escobosa: Well, especially coming from your experience of vulnerable communities and equitable access and understanding the diverse worlds that all the patients live in.
Shruti Kothari: Exactly. And so it was just one of these things I'm just like, there's so much money being poured into healthcare, but the expertise of healthcare and what companies get funded. They're also, I mean, we've heard this now time and time again, but this is back in, 2014, 15, where I was like, all the founders look a little bit the same and have the same background and all these different things, and that's not, if we're trying to solve for all populations and healthcare and diverse problems, why aren't we funding diverse companies and diverse founders? And so I then was like, “Okay, follow the money,” and went to venture capital and at KP’s Venture Fund. And that was wild because that role was focused on scaling. Great. The company funded all these different things. But what happens when you want to scale? And more than often when you, when all, I worked with like over 30 companies and great companies like, like Omada and Ginger and Collective Medical.
Meg Escobosa: Dexcare.
Shruti Kothari: Yes, exactly. It's like, and it was always policy or industry related why something couldn't scale.
Meg Escobosa: And is that information that founders could have figured out even before securing a lot of resources and pursuing the problem, or it's just part of the nature of innovation that yes, they're going to form this solution. And then there's simultaneously going to be the effort to address the policy and limitations.
Shruti Kothari: I think it's work that they can do in advance, but I also think the mind of an innovator and founder isn't always there. So you need to surround yourself with people who might think like that because it's truly like to be an innovator and to think practically, you're thinking like you're going to break systems.
And yes, you can do that in many, many different segments, healthcare is just a wildly different. Like we look at people who have tried to come outside of healthcare to try to disrupt health care and who have like immediately left. Right. And I'm not saying, I mean, I want, we do want those diverse folks coming in and disrupting, but it is, it is recognizing it's a wildly different space and disrupting, like, consumer payment stuff or like whatever.
I would say that, yes, you should be doing that work before, but I don't think if you're an innovator, you're not always thinking in that way. And so think about how complicated healthcare is and to surround yourself or hire people who can think for you in that way and identify.
Meg Escobosa: Excellent. I do want to talk a little bit about your experience as a woman of color in healthcare. Do you want to comment on that? And I'd love to also hear about some of the other work that you're doing around that.
Shruti Kothari: Yeah, no, this is huge. I have in my entire career, except for when I was a health educator, found myself in rooms where I'm the only person like me. Even in equality at that time. It was mostly folks who were, especially where I worked in the type of place and department and so on, was mostly folks who were older white women.
Right? And then it was, venture has its reputation mostly white men, right? Like with a sprinkling of white women and some men of color. So I just, I constantly was the only person like me in the room and constantly actually being asked. I think a lot of, having to represent to represent, but also diminish.
I think that like people sometimes are well intentioned trying to give advice, but very early in my career. I had this advice of like as you can see I like my hoop earrings and my lip color and things like that. And I'm quite bubbly and stuff and early on somebody was like, “No one's going to take you seriously if you speak like that, if you laugh so much, if you wear bright lipsticks, if you wear big earrings,” like all the things, right?
I never had that feedback as a health educator because that made me more relatable to people, right? And so, I could have chosen to believe that and conform, but guess what? At the end of the day, in that role, that was my KP role and quality, the frontline nurses saw me and were like, who is this child telling me, a seasoned home care nurse, what to do about changing perceptions of patients?
If I would have come in there acting super serious and just like, “I'm the expert. Look at me,” like, no one would have believed me. And what I found is basically everything is a version of health education - is how do you make people trust you? Like, how do you actually, you know, part of that is acknowledging who they are, what expertise they are, what expertise that you don't have that they have and being yourself and being personable that people trust in you. Cause if you were prepared with evidence-based information, like all the different things that's the foundation of it, then you just come authentically and so that's something that only took me years. I don't know, there was just a fighting spirit in me that didn't ever want to conform.
And I would have so many people, women of color, come up to me, specifically, and just say, you're so confident, you're yourself, how do you do that? That's amazing. And I didn't know what to say in the beginning of my career because it's just kind of who I am, we need more stories of people that are different and succeeding in their own way on their own pathway and what they're trying to do.
Not everyone has to be these stereotypical things in any of these industries. You need those diverse perspectives, to your point. Like I have a very diverse background, grew up, you know, with a single mother who didn't go to college.
And so I have this very different perspective than somebody who maybe got their MBA from Stanford or Harvard and has legacy families and can get funding like this from somebody because they look the same as the VC funders, right?
You can't see what you don't know and no amount of research is going to make you actually feel those pain points and trigger points and guess what? You're not like the rest of the world like the majority of populations out there and so if you're trying to build and solve for an issue that does affect you greater populations, You need more people like that at the table.
Meg Escobosa: So is this what led to Women of Community?
Shruti Kothari: Yeah. So Women of Community is an organization I started in December 2020, and it was so Mckinsey does this annual report on women in healthcare. And it found that only 4% of women of color are senior leaders in healthcare, 30% white women and the rest are, men, white men, mostly, basically, right?
And I was livid 4% women of color and why I was livid, specifically, and yes, because I think I probably would be in that category and why so few, because I think I'm pretty awesome.
Meg Escobosa: Exactly. There should be more of you
Shruti Kothari: But more so it was during a time. Okay. So it was coming off a presidential election where we were asking women, specifically women of color, to get their communities to come out and vote basically for their communities.
It was during like pandemic times where we were asking women of color to ask their communities to mask up, to ask their communities to keep distance, get vaccinations when they roll out, all these things. So I was like, we play such a foundational role in our communities as far as advancing health and health, all encompassing. And where is the credit, the resources.
Meg Escobosa: The acknowledgement.
Shruti Kothari: Exactly, and so if women of color are so important to advancing health, they should be given leadership positions, basically. It shouldn't be 4%. And when you look at who makes up frontline staff, clinical, not clinical - women of color. When you look at caregivers, family or paid - women of color. It’s disparities of outcomes and like things like black maternal mortality rates. Like it's, why don't we have more women? It's so obvious.
I interviewed some of the big companies involved in that study and their HR leads and things like that. And one of the #1 things that they said, they have no problem getting women of color to come in at the front line, on the ground. And then and our executives, actually, it's that middle funnel that is not there because oftentimes people won't even put themselves up for promotion.
They're at the intersection of all these different things and they're like, “Well, I don't see myself represented in the next layer. And I don't see someone who has to take care of children and her parents and her whole team sort of thing. And so I'm not going to do that.” So for me it became a real clear problem of representation and seeing different stories, and seeing yourself in the next level.
And so Women of Community is all about elevating women of color who are working for the health of their communities. And so we have this, we have an amazing artist partner Matthew Everett is his name, who does these beautiful campaigns with us. We call them Monday Motivation. You should check it out. Women of Communities on Instagram and LinkedIn.
Meg Escobosa: Awesome.
Shruti Kothari: Women Crushing it Wednesday, which is also stories about like, shoutouts. And now our community has grown to over 7,000 in about, a little less than four years. Yeah.
Meg Escobosa: Congratulations. That is so cool. And obviously the response, that's very a desired message of recognition, and I'm so excited for you. And it also seems like your tendency is to take something on and make it. You're not just going to sit around and wait for someone to figure it out and you join. You are the initiator. Where does that come from? Has that been lifelong?
Shruti Kothari: Yeah. I'm a very efficient person, I would say. And so for me, my team always laughs at me because I'm always like, “If there is a block, we don't try to move the big rock out of the way. We just find a road around it, basically,” that's how my brain just naturally thinks, I will say.
I think also like in life, I've just had some things happen to me where I had to figure that out at an early age. My background of every single woman in my family has had an arranged marriage at an early age, basically. My mom got married when she was 17 and didn't go to college, and my grandmother when she was 14.
I don't have examples in my family necessarily of women who have a career and have a lot of education and things like that. And they did the best with what they could do. But so for me, it was a lot of figuring stuff out on my own. And then, as I navigated systems, having a really good foundation, because I do think that it's easy to conform, but it's having a really good foundation and humbling, anchoring to know that you're bringing something special in the world.
So to start things. It's just kind of like what I've always had to do from day one because there was - I didn't see myself in classes. I didn't see myself in whatever from early days, right? It's a natural thing. It's muscle I built up, but I would say that to everyone out there listening. I think too many times people are scared of taking the risks because they don't see themselves in the next step, whatever that is, or they think, “Oh, I'm weak in these areas, so I won't be able to do it,” but a lot of starting something new is building off of your strengths. It's about, “Okay, we have this problem and we want to solve for this problem.” Maybe traditionally people like the role that I have right now, maybe tradition, everyone I work with is very policy forward, very wonky. I'm not, I don't, this is my first job in that type of policy function.
But what I bring is something different. And so as I designed this new program, it was taking my strengths and hiring for what are not my strengths to build a very robust program. But I think you don't have to be the expert in everything. Just have the confidence in yourself to figure it out, basically.
Meg Escobosa: Those are great words. I think that's awesome. It seems like you're involved in a lot of different entities and organizations and you come at healthcare challenges in lots of different ways, leveraging your diverse experience. How do you think about that? Do you have a guiding philosophy?
Shruti Kothari: Yeah. I think, traditionally, how people have thought about careers is that you become the subject matter expert. You climb the ladder. You're like at one company or maybe two or three companies, max, in your entire career.
And I just, we spend more time at work than anywhere else, literally anywhere else. And I think just as you evolve as a human in your personal life, you're trying to evolve professionally, And I think there's also blurred and blended lines sometimes. And we have so many passions and different things, and something you probably have picked up on, and I know, you know, Meg is I have lots of different things I do. I lead industry initiatives for Blue Shield of California. I'm the founder of Women of Community. Also, I'm an advisor tech company called Reverence. I'm an advisor for ScaleHealth.
I'm in like, my gosh, what else? I'm a bit, I'm an advisor for End Well, I'm on the board for Family Caregiver Alliance. I am an advisor for the Asian Pacific fund.
Meg Escobosa: Right. Which are all such great organizations doing really important work. And they're very different.
Shruti Kothari: All very different. The, what the common theme though is they all are something I'm passionate about. It's either caregiving it's about end-of-life and improving experiences around that, or, it's about scaling innovation, essentially. And so why I say that is because that makes my career very fulfilling for me. It also helps me keep me sharp. Once you are at a certain point in your career, or have a certain amount of elevation and privilege to actually influence things. I almost think it is your duty to continue to grow and learn and be a part of different things. Also, one piece of career advice I had from an early mentor when my first jobs was never to fully associate yourself with just one thing and one company because, while a lot of companies are really great, you are one of many to them, right?
And he mentioned that he has seen so many people if they've gotten laid off, unfortunately, or when they retire, lose their entire identity in that process. So anyways, I just I, part of so many amazing organizations. and I do that, yes, because I feel like I have a unique perspective to bring to these organizations, but I also do it for myself, I get as much from it.
Meg Escobosa: Really good advice. And I do think that reflects also the modern world that we're in. There are no careers that are 30 year careers anymore. So you are better served getting exposure to a lot of different things. lso what your career has even shown. You've sat in the different seats in the ecosystem. So that informs, you've got a much more insightful understanding of the different players that you're engaging with. That's a powerful position to be in. Love this advice. And I imagine, does it inform like who you hire and who you engage with?
Shruti Kothari: Yeah. Yeah. Absolutely. Absolutely. I look for where are my weaknesses? I need to I know what my strengths are. I don't need to hire another me. I want somebody who brings something different to the table and forces me to grow in ways that might be painful for me sometimes.
Meg Escobosa: Right, right. Totally. I can relate.
Shruti Kothari: I don't really believe in hierarchical natures of things because if you did the work to hire somebody for their unique perspective, they're not. It's not a tear down sort of thing. It's like they're your partner you know, you as if you are the team lead you, it's your responsibility to support them and advise them in areas they might be weak in that you are really strong and so it's a two way street that way.
And so when I hire people, I look for people again who have the skill sets that I might be lacking in, willing to grow and learn, people who are ambitious and passionate because complacency I think is one of the worst things to bring on to a team and people who are humans like they want to laugh they want to have fun like work it's hard and you know you want people you just can. Even if it's a hard conversation that yeah, they're a good person, I like to laugh with them. I like being around them. This is a hard moment and we'll like it will be fine sort of thing.
Meg Escobosa: We'll get through this. Yeah. Oh, these are great. This is really good insights. And Shruti, this has been a privilege to talk to you. I really enjoy meeting you and learning about your work. I'm inspired by it, and honestly, it feels very real as far as making impact in healthcare, leading transformation feels, oftentimes, like the payer holds the keys and to think that there's transformation coming from the industry is great.
Shruti Kothari: Yeah, I think health plans can get such a bad rep and of course not perfect. There's lots of improvement areas. But what I really do appreciate working for someone like Blue Shield of California, that is very progressive in their thinking and looking at the ecosystem at large. But I will say this, I had very strong biases against working for a health plan, and that's the reason I never thought I'd work for a health plan.
As I was going through all of these phases of my career, you're absolutely correct. Healthplans are some of the most powerful players in the ecosystem. And If you want change, you have to be a part of the table of power, basically. And so the reason why I do feel like Blue Shield of California is such an amazing health plan and how they think is, because they hire for that perspective of difference.
But I went to Berkeley School of Public Health, where they would be a lot of trash talking sometimes, right? And like, oh my god, we were not bleeding hearts, I will say, right? If you were a bleeding heart, you're exactly the type of person we need at healthplans, you know, and other and venture capital and other ecosystems that don't have the best reputations because we need that to disrupt and better fund companies who are diverse and advocate for that.
We need where we're putting our vendor dollars and looking at topics of coverage, like housing or like black maternal mortality, things like that. So anyways, I just wanted to add that because I think that's so important. So I would ask the audience listening if they are going through something like that to challenge them to think about it differently and how these organizations or these ecosystems need their voices to actually disrupt it.
Meg Escobosa: Thank you so much, Shruti. This is awesome.
Shruti Kothari: Thank you so much. This is awesome. I could talk all day with you, Meg.
Meg Escobosa: Same. Honestly, I've learned so much, and I just, yeah, you're doing really good work, and we wish you the best.
Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho Medina Sabich, Wendy Nielsen, and me, Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts. It really does make a difference and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions, please email us at podcast@thekrinskyco.com and visit us on the web at www.thekrinskyco.com.
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Meg Escobosa: Welcome to the Game-Changing Women of Healthcare, featuring exceptional women making an impact in healthcare today. Together, we dig into the many healthcare issues we face today and how these innovative leaders are working to solve them. We celebrate our guests’ accomplishments, setbacks, and the lessons they've learned throughout their careers.
I'm Meg Escobosa. Join me in conversation with some of the many brilliant and courageous women on the front lines of the future of health.
Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. A quick note before we get into today's episode, we are currently looking for sponsors for the podcast. If supporting and encouraging female leadership in healthcare is important to you or your organization, help us do that by becoming a sponsor of the Game-Changing Women of Healthcare, reach our engaged audience with a mention by me in future episodes, or we'll produce a short audio spot for your organization. At The Krinsky Company, we believe in female and diverse leadership in healthcare. If that's important to you too, become a sponsor of the podcast and proudly share your values with the world. Reach out to us at podcast@thekrinskyco.com and thank you.
Meg Escobosa: Welcome back to The Game-Changing Women of Healthcare. I'm your host, Meg Escobosa. Today on the show, we have Shruti Kothari, who is the
Director of Industry Initiatives at Blue Shield of California. She is an advocate for equitable healthcare transformation, leveraging her experience in health education, community mobilization, quality improvement, early stage startups, and in venture capital.
She is passionate about creating meaningful healthcare experiences for patients, families and providers. We are so thrilled to have you. Welcome to the show, Shruti.
Shruti Kothari: Thank you, Meg. It's an honor to be here. Thank you for having me.
Meg Escobosa: So you're leading Blue Shield of California's healthcare agenda, helping to celebrate this transformation of the healthcare system. And I know your aims are to make it universal, equitable, affordable, high quality, comprehensive, digital, simple, and sustainable, which are amazing qualities. How are you going about it? And what do you believe are some of the enabling factors? And have you encountered any resistance?
Shruti Kothari: Yeah. Super easy to do, right? All those things that you mentioned, I don't know why anybody else in healthcare hasn't figured it out yet. Yeah, so I lead a group called Industry Initiatives for Blue Shield of California. And what this concept basically is, is that all of us in the ecosystem, I think it's rare for someone to get into healthcare to not have some sort of mission orientation.
So all of us want all the things that you just said in the ecosystem and whether you're a provider, health plan, advocacy group, whatever, that is your ultimate goal. But when we think about it, we create these transformation agendas, these reform agendas, these innovation agendas, and we have these goals associated with them, and we pilot and test changes and they can either be vendor-related or process-related, the whole spectrum of things, and then when a pilot has success and we want to scale it, that's actually one of the hardest things. It is, how do you scale that? And some of the reasons for why it's so hard is that our ecosystem is misaligned, there's fragmentation. We have for, I mean, I'm even going to say as bold to say centuries, been, making workarounds and different things. And so as a result, it becomes very hard to scale without co-opetition and collaboration. And so that is what the whole premise of industry initiatives is.
If we want health reform and we want healthcare transformation, we need to collaborate with one another in the ecosystem and we need to co-opetate with folks who might traditionally be our competitors. So to your question, what we are trying to do is at Blue Shield of California, our healthcare transformation agenda: where have we piloted and tested and have seen really substantial evidence, that's positive, coming out of this of it related to equity, access, equality, all the things. But there are specific policy or industry barriers preventing the scale of those things.
Meg Escobosa: And can you elaborate on what some of those policy barriers are and maybe listeners who are part of this ecosystem have ideas about how to address that.
Shruti Kothari: Yeah, the areas that we are focused on for industry initiatives is payment innovation, and very specifically, advanced payment models in primary care. Data sharing and when we look at that, looking at a health information exchange that's universal, with all the players in the ecosystem. And then third is integrated behavioral health and so looking at collaborative care models and how they integrate both with finance and so on in primary care.
Meg Escobosa: Great. Well, I know that there is the effort to establish a healthcare information exchange in California.
Shruti Kothari: Yes.
Meg Escobosa: That has hit some barriers in the past and now we're at a new juncture and there's new effort to create.
Shruti Kothari: Yeah, yeah, absolutely.
Meg Escobosa: Are you part of that effort? Are you part of the ecosystem? Okay, very cool.
Shruti Kothari: Yeah, so for the data-sharing work for folks that may not know, for over 20 years, we have been trying to get a data-sharing health information exchange mandate placed in the state of California. But because again of misaligned incentives it just hasn't happened. And the pandemic was actually a really crucial moment where we saw other states who do have a HIE infrastructure really have amazing outcomes utilizing that with vaccination rollouts, with tracking, with lots of different things.
And so it was ripe in, around at the end of 2020 to really go hard and try to get policy passed. So Blue Shield of California industry initiatives, we were able to essentially start a coalition and move something. And so, Blue Path Health is the folks that we chose to start that coalition today.
I'm just going to fast forward. It was really hard, but that coalition is a standalone organization, a nonprofit with multiple funders, has thousands of organizations across the ecosystem and healthcare who are participating. And we did get legislation passed in 2021, which is again, over 20 years, people have been trying to do this and continue to advocate for amendments and things like that to make it more operational.
Meg Escobosa: Congratulations. That's a huge accomplishment given the history. I love the example that you gave about being able to tie, you know, using health data, integrated health data to improve vaccine rollouts and just have awareness of people, you know, how big, how many, I guess, citizens, community members have gotten access to care.
Is that the holy grail? What is the ultimate benefit of bringing all this data together?
Shruti Kothari: For you as a patient, if you get seen in an ED, That is not like your ED that you, you know, like in-network or something just because it's an emergency and that happens and then you have to go to your primary care provider who might be in a different network.
Right now, it's very challenging to share those records with this, it would be seamless in that way, right? There'd be one health information exchange where everyone who is a qualified provider and you yourself can access your information, regardless.
Meg Escobosa: Yeah, amazing. Very cool. So in terms of the, so the policy barriers and what were some of the other barriers, are there other barriers we should be aware of that we can tackle?
Shruti Kothari: Industry barriers are pretty huge in our ecosystem. And so, our payment work really is a great example of that. So what our payment work is, is we've all heard value-based payment models, right?
Like it is the buzziest, like let's throw this out. And so everyone talks about how it's wonderful and how it is a wave of the future and how we need to be doing it. Blue Shield of California was the only health plan actually testing value-based payment models. And so we got to a point where we had great outcomes, our providers that we were testing with were positive. Everyone was positive. The challenge is when you look to larger provider groups and they contract with multiple health plans, you can't change your internal processes, how you contract, all the different things for one health plan. You got to get all the health plans on the board to do this. And so it was ripe for an industry initiative sort of area to focus on because we were at that stage. Now, health plans aren't they're not best friends.
Meg Escobosa: Right? Exactly.
Shruti Kothari: Nationally speaking, but that's not what we are, our concept is based off of, and so we try to actually facilitate some of these conversations ourselves early days, but I get it. I wouldn't, why would you trust your person that's been a competitor for years and years, right? And so we realized this is a much bigger collaborative effort. So we worked with Integrated Healthcare Association, PBGH’s California Quality Collaborative to get several health plans at the table to talk about this, like, “Great, let's talk about value-based payment models and how do we actually execute this in reality?”
These discussions really took almost two years to get to the point of we now have a public MOU out and are now in the stage of actually piloting with a total of four health plans. And so that's, that's huge. That's groundbreaking. And so like an industry example.
Meg Escobosa: That's great. Do you have any secrets for how to get people to the table to have this conversation where the are kind of skills that you relied on that encourage people to the table?
Shruti Kothari: And I'm going to take one step back before I say this because industry initiatives - I don't know of any other health plan that has a team like this as truly forward leaning and innovative and looking progressively.
Meg Escobosa: Yeah. Where did it come from? This industry initiatives team.
Shruti Kothari: So this came from our CEO, Paul Markovich, and our Executive Vice President of Transformation, Peter Long. So two of the senior most people in our organization. It's an idea that they had, and so they had buy-in. Peter Long is our executive sponsor. He helps us with all of our strategy. So these folks, there is executive buy in top visibility. There are resources allocated to this work. There's teams. There's dollars to do things. And in health care, I mean, how many of us have heard of a really cool, buzzy job, and when you dig in a little further, there's no funding, there's no resources. You know, and so this in concept is amazing, but you need the resources to do it and we have it. So one, that's how it got started and it was foundationally set up really properly in order to execute on the work in a real way and then second the secret sauce, kind of, is realizing our place as a health plan and we want to collaborate and have co-opetition, but are we the most trustworthy source like to go to a competitor and say, “Hey, partner with us and whatever, even though we have the best of intentions,” probably not.
So the secret sauce is actually finding a third party that is neutral and has trust from everyone in the ecosystem and also has that same mission and vision, and to partner with them. So for our payment work, it really is, we could not have done this without Integrated Healthcare Association and that California Quality Collaborative group at all.
Meg Escobosa: That's awesome. Great to recognize that. And so who are, would you mind naming some of the other health plans that are involved?
Shruti Kothari: Yeah. So the folks that are on the public MOU and have committed to allocating resources and piloting for the advanced primary care work is us with Aetna, HealthNet, and Elevance.
Meg Escobosa: Fabulous. I'd love to dig into alternative payment models or new payment models besides. the concept of value based care where you pay an upfront amount, this is the amount we're going to pay you per patient, take care of them with these resources, and if you save money, great. And if you need more money, sorry, you know, that's your loss, providers. What are you trying that's new beyond that? Is there some other ideas on the table?
Shruti Kothari: Yeah. So actually this is a great distinction so oftentimes this work that I'm mentioning relies on the operational business units within a health plan, right?
Like you, you took it on, you piloted, you tested, and now you get it to scale. That's so much work, right? So we are not the group that is the operational business unit owners. We have a fabulous relationship with our executives and leads in those groups. But what we are is we're to support them to help scale that.
And so, there are things that they are doing outside of this, but for us, where we swoop in is like, okay, it's ready for scale. Great. And, so our SMEs, our business folks, let's go in and let's help them. And this is a partnership with them in order to scale this amazing work we're trying to scale.
And for us at Industry Initiatives, it is really focused on this with the advanced paid models, and I also say this because if there are folks listening who are like, “Oh, this is a great idea. We want to start this in our organization, and da da da,” we're now in year four of this program and we had some amazing wins, and so there's a lot of energy around trying to partner on projects. And we have realized there is a recipe of success for what a good program to take on and scale. And one of those components is a really strong business unit with partners who can partner with us, externally, to move these things.
Meg Escobosa: Very good. Okay. Let's talk about scaling because you worked at Kaiser Ventures. Was a big part of that, figuring out how to scale or the potential for scale for a new concept. Talk to us about that. What are your insights about what it takes to scale?
Shruti Kothari: So yes. So Kaiser Permanente's venture group, I was our first ever lead for strategic engagement, and what that basically meant is it was my job to know all of our portfolio companies, help them with their product development and business strategy and to think through, you know, if they were not Kaiser Permanente already, like to get those insights to help them. And then also if they were already implemented within KP in some way, how do we scale that through different regions and so on, and or make sure that partnership is continuing to evolve with our business of Kaiser Permanente. There are so many learnings and my background too, is I was an early stage startup implementer. I was one of the first employees at Honor, and then also before that have led national quality programs at Kaiser Permanente.
And so, I have this unique perspective of the system sides as well as being a frontline operator at a startup. And I think a death trap for so many smaller stage companies is that they see the business of something like a Kaiser Permanente or like a big organization of like, “Oh my God, if we just get this contract,” right?
Oh man. So many small companies have smaller stage companies have gone to die on that road because it's right. It's like it is. One of the biggest things I will tell companies is to sniff out if there's actually a there there. There are a lot of priorities in healthcare. Very few are funded, basically.
Now, we can say, That was one of my big jobs in that role was, okay, great. This is on our agenda of what our top priorities. Let me go talk to all the regional health plan leaders, all the regional medical group leaders, because they can have different perspectives than national leaders and see if there's actually funding to do this work.
And if we're even partnering externally for this work or building internally.
Meg Escobosa: And presumably that there is the step even before that, which is to say,” Is this need a priority that this solution is solving. This solution addresses this problem.” Is that important to you? And then on top of that, is there funding?
Shruti Kothari: And also another key thing to look out for is what is the road map? What is the internal roadmap for goals? Is it like a one year thing? Then it's a little questionable of like, are, there not going to be resources past year or two. What's happening? And so, there's just this investigative work to be done to uncover.
I think people take too many things at face value and healthcare of like, “Oh, but there was this big article about how we're now focusing on, you know”, I'm making a silly example, “giving dogs to every member that comes into their door. And it's like, okay, that's great that there was a big public announcement made, but is that real? Let's dig in a little further.
And so my best advice coming from that role to companies who might not have a navigator, like me within the ecosystem to help is oftentimes, when people get a meeting with somebody within that company, it's sales pitch, sales pitch, sales pitch. One, you might not be talking to the right leader who can make that decision. Who's making a decision. We all know that burnout of like when you email somebody and you'll get no response back. It's probably because they don't make vendor decisions and just don't have time to have a conversation with you.
And your email is very strong on sale. Use it as an example to get to know whether that is a top priority for that organization, whether they have funding, whether they're the right lead, build a rapport so they might introduce you to the right lead. If they're not that right lead, it's very, very simple things, but I think you're looking at it more as an investigator than a seller.
Meg Escobosa: You know, I was thinking about the fact that you've got this amazing diverse experience. Oftentimes, you know, looking back on your career, you can see the path, how you got to where you are, and that all makes sense, but even in your case, given your role at a health plan, how different is this view from the others and how much does your prior experience inform what you're doing now?
Shruti Kothari: Yeah. Oh my gosh, this is such a, this is a very interesting question for me because I never thought I'd work for a health plan.
Meg Escobosa: Right like out there first working with patients health education.
Shruti Kothari: Totally.
Meg Escobosa: Mobilizing community
Shruti Kothari: Absolutely, like this is a real thing. So, I started my career as a health educator in vulnerable communities for the American Cancer Society. And I will say that the way my career has worked is because of my mission of creating that transformation.
So, you know, as a health educator, it was like great direct one-on-one impact in the communities. But as I was out there, I was really seeing that there's a lot of issues and challenges. Within the systems, like the quality of things and using children as medical interpreters and, all these different.
Meg Escobosa: Yes.
Shruti Kothari: Right? And so then I was like, “Okay, great. Well, I'm going to go get an MPH and I'm going to go work at a systems level and improve quality and care experience,” and that's what I did. And then I went to Kaiser Permanente and I became their national lead for, it was at the onset of public reporting for medical home care.
So I, and I say this because I was quite young. I was in my mid-twenties and It was during a time when it was so inpatient-focused, that they were like, “Oh, like we even have a medical home care program? I didn't even know,” a sort of thing. Okay. Well, let's just hire somebody to kind of work on it.
And so I had this big role without people even realizing it when I came in as my first job out of grad school, it was at the onsite public reporting. It was the national quality lead for medical home health, hospice, and home based palliative care. It grew over the years of the course of like four years, but it started with medical home care.
And I say this because I think sometimes people chase the shiny star. That time that I went into that was not a shiny star. It was like, “What is even home care? What is that?” But in that time it became the buzziest thing. That's where care was moving. And so, doing that work, I just saw there were so many low hanging fruit in that space around innovation and technology so when it did become buzzy, and I had the opportunity to join a very well-funded startup. So for Honor, the startup that I had joined, they had just it was like four or five people, and they just raised $20M. And Marc Andreessen sat on the board of the company, which is a very rare thing.
And so, but they had been quoted in some things around home care and things like that. And it just worked out organically for me. It wasn't a part of the career.
Meg Escobosa: You were like the necessary expert on the team.
Shruti Kothari: Exactly.
Meg Escobosa: Industry expert.
Shruti Kothari: Exactly, and going from big company like that to small and doing all the things was like, one day, maybe I'm finding office space for us and one day, you know, I'm like, just like leading these programs and hiring your caregivers and all these different things. It was a wild experience. But what I learned from that is that there's such a disconnect because Honor has probably pivoted several times since that and what they deliver.
And I was one of the only healthcare people early days until I would say a full year into, and that's a long time for early-stage startup until they started having more healthcare-type of people. And it was really challenging at times. And anyone who's been at a company like this probably knows this, where there are more people who maybe are coming from the tech world and not the healthcare world, where there's simple things that you have to justify, like, for example, having a phone number to call for home care instead of it just being an app. We in healthcare think, “Oh, obvious.
Meg Escobosa: Well, especially coming from your experience of vulnerable communities and equitable access and understanding the diverse worlds that all the patients live in.
Shruti Kothari: Exactly. And so it was just one of these things I'm just like, there's so much money being poured into healthcare, but the expertise of healthcare and what companies get funded. They're also, I mean, we've heard this now time and time again, but this is back in, 2014, 15, where I was like, all the founders look a little bit the same and have the same background and all these different things, and that's not, if we're trying to solve for all populations and healthcare and diverse problems, why aren't we funding diverse companies and diverse founders? And so I then was like, “Okay, follow the money,” and went to venture capital and at KP’s Venture Fund. And that was wild because that role was focused on scaling. Great. The company funded all these different things. But what happens when you want to scale? And more than often when you, when all, I worked with like over 30 companies and great companies like, like Omada and Ginger and Collective Medical.
Meg Escobosa: Dexcare.
Shruti Kothari: Yes, exactly. It's like, and it was always policy or industry related why something couldn't scale.
Meg Escobosa: And is that information that founders could have figured out even before securing a lot of resources and pursuing the problem, or it's just part of the nature of innovation that yes, they're going to form this solution. And then there's simultaneously going to be the effort to address the policy and limitations.
Shruti Kothari: I think it's work that they can do in advance, but I also think the mind of an innovator and founder isn't always there. So you need to surround yourself with people who might think like that because it's truly like to be an innovator and to think practically, you're thinking like you're going to break systems.
And yes, you can do that in many, many different segments, healthcare is just a wildly different. Like we look at people who have tried to come outside of healthcare to try to disrupt health care and who have like immediately left. Right. And I'm not saying, I mean, I want, we do want those diverse folks coming in and disrupting, but it is, it is recognizing it's a wildly different space and disrupting, like, consumer payment stuff or like whatever.
I would say that, yes, you should be doing that work before, but I don't think if you're an innovator, you're not always thinking in that way. And so think about how complicated healthcare is and to surround yourself or hire people who can think for you in that way and identify.
Meg Escobosa: Excellent. I do want to talk a little bit about your experience as a woman of color in healthcare. Do you want to comment on that? And I'd love to also hear about some of the other work that you're doing around that.
Shruti Kothari: Yeah, no, this is huge. I have in my entire career, except for when I was a health educator, found myself in rooms where I'm the only person like me. Even in equality at that time. It was mostly folks who were, especially where I worked in the type of place and department and so on, was mostly folks who were older white women.
Right? And then it was, venture has its reputation mostly white men, right? Like with a sprinkling of white women and some men of color. So I just, I constantly was the only person like me in the room and constantly actually being asked. I think a lot of, having to represent to represent, but also diminish.
I think that like people sometimes are well intentioned trying to give advice, but very early in my career. I had this advice of like as you can see I like my hoop earrings and my lip color and things like that. And I'm quite bubbly and stuff and early on somebody was like, “No one's going to take you seriously if you speak like that, if you laugh so much, if you wear bright lipsticks, if you wear big earrings,” like all the things, right?
I never had that feedback as a health educator because that made me more relatable to people, right? And so, I could have chosen to believe that and conform, but guess what? At the end of the day, in that role, that was my KP role and quality, the frontline nurses saw me and were like, who is this child telling me, a seasoned home care nurse, what to do about changing perceptions of patients?
If I would have come in there acting super serious and just like, “I'm the expert. Look at me,” like, no one would have believed me. And what I found is basically everything is a version of health education - is how do you make people trust you? Like, how do you actually, you know, part of that is acknowledging who they are, what expertise they are, what expertise that you don't have that they have and being yourself and being personable that people trust in you. Cause if you were prepared with evidence-based information, like all the different things that's the foundation of it, then you just come authentically and so that's something that only took me years. I don't know, there was just a fighting spirit in me that didn't ever want to conform.
And I would have so many people, women of color, come up to me, specifically, and just say, you're so confident, you're yourself, how do you do that? That's amazing. And I didn't know what to say in the beginning of my career because it's just kind of who I am, we need more stories of people that are different and succeeding in their own way on their own pathway and what they're trying to do.
Not everyone has to be these stereotypical things in any of these industries. You need those diverse perspectives, to your point. Like I have a very diverse background, grew up, you know, with a single mother who didn't go to college.
And so I have this very different perspective than somebody who maybe got their MBA from Stanford or Harvard and has legacy families and can get funding like this from somebody because they look the same as the VC funders, right?
You can't see what you don't know and no amount of research is going to make you actually feel those pain points and trigger points and guess what? You're not like the rest of the world like the majority of populations out there and so if you're trying to build and solve for an issue that does affect you greater populations, You need more people like that at the table.
Meg Escobosa: So is this what led to Women of Community?
Shruti Kothari: Yeah. So Women of Community is an organization I started in December 2020, and it was so Mckinsey does this annual report on women in healthcare. And it found that only 4% of women of color are senior leaders in healthcare, 30% white women and the rest are, men, white men, mostly, basically, right?
And I was livid 4% women of color and why I was livid, specifically, and yes, because I think I probably would be in that category and why so few, because I think I'm pretty awesome.
Meg Escobosa: Exactly. There should be more of you
Shruti Kothari: But more so it was during a time. Okay. So it was coming off a presidential election where we were asking women, specifically women of color, to get their communities to come out and vote basically for their communities.
It was during like pandemic times where we were asking women of color to ask their communities to mask up, to ask their communities to keep distance, get vaccinations when they roll out, all these things. So I was like, we play such a foundational role in our communities as far as advancing health and health, all encompassing. And where is the credit, the resources.
Meg Escobosa: The acknowledgement.
Shruti Kothari: Exactly, and so if women of color are so important to advancing health, they should be given leadership positions, basically. It shouldn't be 4%. And when you look at who makes up frontline staff, clinical, not clinical - women of color. When you look at caregivers, family or paid - women of color. It’s disparities of outcomes and like things like black maternal mortality rates. Like it's, why don't we have more women? It's so obvious.
I interviewed some of the big companies involved in that study and their HR leads and things like that. And one of the #1 things that they said, they have no problem getting women of color to come in at the front line, on the ground. And then and our executives, actually, it's that middle funnel that is not there because oftentimes people won't even put themselves up for promotion.
They're at the intersection of all these different things and they're like, “Well, I don't see myself represented in the next layer. And I don't see someone who has to take care of children and her parents and her whole team sort of thing. And so I'm not going to do that.” So for me it became a real clear problem of representation and seeing different stories, and seeing yourself in the next level.
And so Women of Community is all about elevating women of color who are working for the health of their communities. And so we have this, we have an amazing artist partner Matthew Everett is his name, who does these beautiful campaigns with us. We call them Monday Motivation. You should check it out. Women of Communities on Instagram and LinkedIn.
Meg Escobosa: Awesome.
Shruti Kothari: Women Crushing it Wednesday, which is also stories about like, shoutouts. And now our community has grown to over 7,000 in about, a little less than four years. Yeah.
Meg Escobosa: Congratulations. That is so cool. And obviously the response, that's very a desired message of recognition, and I'm so excited for you. And it also seems like your tendency is to take something on and make it. You're not just going to sit around and wait for someone to figure it out and you join. You are the initiator. Where does that come from? Has that been lifelong?
Shruti Kothari: Yeah. I'm a very efficient person, I would say. And so for me, my team always laughs at me because I'm always like, “If there is a block, we don't try to move the big rock out of the way. We just find a road around it, basically,” that's how my brain just naturally thinks, I will say.
I think also like in life, I've just had some things happen to me where I had to figure that out at an early age. My background of every single woman in my family has had an arranged marriage at an early age, basically. My mom got married when she was 17 and didn't go to college, and my grandmother when she was 14.
I don't have examples in my family necessarily of women who have a career and have a lot of education and things like that. And they did the best with what they could do. But so for me, it was a lot of figuring stuff out on my own. And then, as I navigated systems, having a really good foundation, because I do think that it's easy to conform, but it's having a really good foundation and humbling, anchoring to know that you're bringing something special in the world.
So to start things. It's just kind of like what I've always had to do from day one because there was - I didn't see myself in classes. I didn't see myself in whatever from early days, right? It's a natural thing. It's muscle I built up, but I would say that to everyone out there listening. I think too many times people are scared of taking the risks because they don't see themselves in the next step, whatever that is, or they think, “Oh, I'm weak in these areas, so I won't be able to do it,” but a lot of starting something new is building off of your strengths. It's about, “Okay, we have this problem and we want to solve for this problem.” Maybe traditionally people like the role that I have right now, maybe tradition, everyone I work with is very policy forward, very wonky. I'm not, I don't, this is my first job in that type of policy function.
But what I bring is something different. And so as I designed this new program, it was taking my strengths and hiring for what are not my strengths to build a very robust program. But I think you don't have to be the expert in everything. Just have the confidence in yourself to figure it out, basically.
Meg Escobosa: Those are great words. I think that's awesome. It seems like you're involved in a lot of different entities and organizations and you come at healthcare challenges in lots of different ways, leveraging your diverse experience. How do you think about that? Do you have a guiding philosophy?
Shruti Kothari: Yeah. I think, traditionally, how people have thought about careers is that you become the subject matter expert. You climb the ladder. You're like at one company or maybe two or three companies, max, in your entire career.
And I just, we spend more time at work than anywhere else, literally anywhere else. And I think just as you evolve as a human in your personal life, you're trying to evolve professionally, And I think there's also blurred and blended lines sometimes. And we have so many passions and different things, and something you probably have picked up on, and I know, you know, Meg is I have lots of different things I do. I lead industry initiatives for Blue Shield of California. I'm the founder of Women of Community. Also, I'm an advisor tech company called Reverence. I'm an advisor for ScaleHealth.
I'm in like, my gosh, what else? I'm a bit, I'm an advisor for End Well, I'm on the board for Family Caregiver Alliance. I am an advisor for the Asian Pacific fund.
Meg Escobosa: Right. Which are all such great organizations doing really important work. And they're very different.
Shruti Kothari: All very different. The, what the common theme though is they all are something I'm passionate about. It's either caregiving it's about end-of-life and improving experiences around that, or, it's about scaling innovation, essentially. And so why I say that is because that makes my career very fulfilling for me. It also helps me keep me sharp. Once you are at a certain point in your career, or have a certain amount of elevation and privilege to actually influence things. I almost think it is your duty to continue to grow and learn and be a part of different things. Also, one piece of career advice I had from an early mentor when my first jobs was never to fully associate yourself with just one thing and one company because, while a lot of companies are really great, you are one of many to them, right?
And he mentioned that he has seen so many people if they've gotten laid off, unfortunately, or when they retire, lose their entire identity in that process. So anyways, I just I, part of so many amazing organizations. and I do that, yes, because I feel like I have a unique perspective to bring to these organizations, but I also do it for myself, I get as much from it.
Meg Escobosa: Really good advice. And I do think that reflects also the modern world that we're in. There are no careers that are 30 year careers anymore. So you are better served getting exposure to a lot of different things. lso what your career has even shown. You've sat in the different seats in the ecosystem. So that informs, you've got a much more insightful understanding of the different players that you're engaging with. That's a powerful position to be in. Love this advice. And I imagine, does it inform like who you hire and who you engage with?
Shruti Kothari: Yeah. Yeah. Absolutely. Absolutely. I look for where are my weaknesses? I need to I know what my strengths are. I don't need to hire another me. I want somebody who brings something different to the table and forces me to grow in ways that might be painful for me sometimes.
Meg Escobosa: Right, right. Totally. I can relate.
Shruti Kothari: I don't really believe in hierarchical natures of things because if you did the work to hire somebody for their unique perspective, they're not. It's not a tear down sort of thing. It's like they're your partner you know, you as if you are the team lead you, it's your responsibility to support them and advise them in areas they might be weak in that you are really strong and so it's a two way street that way.
And so when I hire people, I look for people again who have the skill sets that I might be lacking in, willing to grow and learn, people who are ambitious and passionate because complacency I think is one of the worst things to bring on to a team and people who are humans like they want to laugh they want to have fun like work it's hard and you know you want people you just can. Even if it's a hard conversation that yeah, they're a good person, I like to laugh with them. I like being around them. This is a hard moment and we'll like it will be fine sort of thing.
Meg Escobosa: We'll get through this. Yeah. Oh, these are great. This is really good insights. And Shruti, this has been a privilege to talk to you. I really enjoy meeting you and learning about your work. I'm inspired by it, and honestly, it feels very real as far as making impact in healthcare, leading transformation feels, oftentimes, like the payer holds the keys and to think that there's transformation coming from the industry is great.
Shruti Kothari: Yeah, I think health plans can get such a bad rep and of course not perfect. There's lots of improvement areas. But what I really do appreciate working for someone like Blue Shield of California, that is very progressive in their thinking and looking at the ecosystem at large. But I will say this, I had very strong biases against working for a health plan, and that's the reason I never thought I'd work for a health plan.
As I was going through all of these phases of my career, you're absolutely correct. Healthplans are some of the most powerful players in the ecosystem. And If you want change, you have to be a part of the table of power, basically. And so the reason why I do feel like Blue Shield of California is such an amazing health plan and how they think is, because they hire for that perspective of difference.
But I went to Berkeley School of Public Health, where they would be a lot of trash talking sometimes, right? And like, oh my god, we were not bleeding hearts, I will say, right? If you were a bleeding heart, you're exactly the type of person we need at healthplans, you know, and other and venture capital and other ecosystems that don't have the best reputations because we need that to disrupt and better fund companies who are diverse and advocate for that.
We need where we're putting our vendor dollars and looking at topics of coverage, like housing or like black maternal mortality, things like that. So anyways, I just wanted to add that because I think that's so important. So I would ask the audience listening if they are going through something like that to challenge them to think about it differently and how these organizations or these ecosystems need their voices to actually disrupt it.
Meg Escobosa: Thank you so much, Shruti. This is awesome.
Shruti Kothari: Thank you so much. This is awesome. I could talk all day with you, Meg.
Meg Escobosa: Same. Honestly, I've learned so much, and I just, yeah, you're doing really good work, and we wish you the best.
Thanks for joining us for the Game Changing Women of Healthcare, a production of The Krinsky Company. Today's episode was produced by Calvin Marty, Chelsea Ho Medina Sabich, Wendy Nielsen, and me, Meg Escobosa. This podcast is engineered, edited, mixed and scored by Calvin Marty. If you enjoy the show, please consider leaving a rating and review wherever you get your podcasts. It really does make a difference and share the show with your friends and colleagues. If you have any questions, comments, or guest suggestions, please email us at podcast@thekrinskyco.com and visit us on the web at www.thekrinskyco.com.
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