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Covered California to offer Blue Shield’s ACO HMO plans

BY JEFF ROBERTSON – Blue Shield’s nationally recognized Accountable Care Organization (ACO) program is expanding in 2017, as we make ACO HMO plans available to individuals and families shopping on Covered California.

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) Consumer Information and Insurance Oversight (CIIO) featured the expansion of our Trio product into Covered California (and off-exchange) for 2017 in the first edition of their Marketplace Innovation newsletter. The newsletter is intended for a national policy-focused audience, highlighting industry-related information that helps better serve consumers,  including innovative practices around care coordination, provider contracting, and consumer engagement.

Trio health plans, which were initially developed for California’s employer-group market, leverage Blue Shield’s ACO model, providing members with access to coordinated care and simplified communication, all while holding Blue Shield, doctors and hospitals accountable for the quality and cost of care. The result is an innovative next-generation product that benefits consumers through better coordinated care, improved outcomes and reduced costs.

When Trio plans become available to individuals and families in Covered California, they will be listed as BSC HMO, however “Trio” will printed be on the member’s ID card.

Plan features include Shield Concierge, which helps members understand their coverage, find a doctor or specialist, address questions about prescriptions, understand doctors’ instructions, and transfer medical records. And, it gives members one phone number to call for all benefit and health-related questions. The concierge team consists of experienced health advocates, registered nurses, social workers, health coaches, clinical support coordinators, pharmacists, pharmacy technicians, and dedicated customer service representatives.

Other features of our ACO HMO plans include Wellvolution and Teladoc. Wellvolution includes a variety of innovative wellness programs using the latest online and mobile technologies to make wellness rewarding, easy, social, and fun. Teladoc offers members remote access to physicians via telephone and secure video consults for diagnosis and treatment when they are unable to leave home or after office hours.

Since we launched our first ACO in Northern California in 2010, we now have more than 37 across the state serving 340,000 people. During that time, we’ve been able to provide access to quality care while controlling health care costs. For example, over the past six years, the average annual cost of healthcare increase across our ACO network was below 3 percent, compared to an estimated 7 percent increase for non-ACO providers in the state.

Extending Trio health plans that utilize our proven ACO network to the individual market will help us continue to create a sustainable healthcare system while providing Californians access to quality care that is more personal and meets their specific needs.

Jeff Robertson is senior vice president and chief marketing officer at Blue Shield of California.