Blue Shield Agrees with Covered California Regarding the Need to Assign PCP’s

by John Hansen

Blue Shield of California Embraces the Mandate to Assign Primary Care Physicians (PCP’s)

Covered California has mandated that all carriers assign Primary Care Physicians (PCP’s) to all their members. Many expected PPO’s like Blue Shield of California to balk at this. However, top leaders at Blue Shield agree that this move is in everyone’s best interest.

Of the 1.6 million insured in the Covered California Exchange, a huge amount of these new members are not going to the doctor. They’re not getting their checkups, and they’re not getting their free preventative tests.

Obamacare’s Free Preventative Care Only Helps If You Use It

The whole point of free preventative care made available on Obamacare California plans was to increase the health of the population. However, if enrollees are not availing themselves to these services, the free preventative care is all for naught. Ultimately, the only way to make health care more affordable in California is to get people healthier. Otherwise, costs will just continue to rise.

Toward that goal of getting California healthy, state legislators and health care experts know that we need to get more people using services, especially preventative care. We’ve got to get everyone a doctor, and once we’ve done that, we’ve got to get them to go see their primary care physician.

PPO’s Realize that Now is the Time to Assign PCP’s and Get People to the Doctor

“We’re working to get people to the doctor to get their tires checked,” says Jeff Smith, Vice President of Individual and Family Plans for Blue Shield of California. Getting everyone a PCP, helps in making that connection.

Top leaders agree that this is great for the Hispanic community in California. Hispanics, especially those who speak little English, have had a harder time knowing where to go to see a doctor. Carrier websites are confusing to them. So this should really help.

Top leaders at Blue Shield of California are focusing on a key question: “In the PPO environment, what are we doing to get people to get their checkups?”

The PPO motto has been choice: “Health care when you want it where you want it.” However, in the new world of Obamacare, the PPO’s are going to have to drive home another message. They have to encourage clients to go see the doctor, get their checkups, and get their labs done.

If the PPO’s do not embrace this message, ultimately they will become obsolete. HMO’s like Kaiser Permanente are getting better and better at getting their members to do their checkups and manage their health. This causes the Kaiser pool of members to grow healthier while the PPO’s membership grows more sickly. So getting members to the doctor is a matter of survival for PPO’s like Anthem Blue Cross, Blue Shield of California and Health Net.

The Problem of Administration

The old motto, “Easier said than done”, definitely applies here. How do you get millions of insured all assigned to a primary care physician? If not done right, carriers and agents could get a lot of calls from frustrated doctors and frustrated health plan members.

One concerned agent asked, “What if a doctor gets assigned too many patients?” A top leader at Blue Shield of California responded, “We will spread clients across doctors to avoid that. And, we will try to assign the doctor you already have if you have one.” But she added later, “Be ready for the calls.”

The Problem of Scaring PPO Members

PPO clients are NOT used to being assigned doctors, so that could alarm them. Agents and carrier representatives will need to know how to field these calls. The message they’ll need to get across is “nothing has really changed.”

Yes, you will be assigned a doctor. However, you can still see whoever you want whenever you want.

No. There’s no gatekeeper. If you’re on a PPO, you don’t have to have a referral from your primary care physician (assigned or otherwise). Also, you don’t have to use the PCP you have been assigned.



Not sure how Obamacare affects your health care plans in California? Learn how the ACA works in California, including benefits, costs and enrollment.

Covered California is the Golden State’s official health exchange marketplace where individuals, families and small businesses can find high-quality, low-cost California government health insurance.

Learn about Obamacare income guidelines in California using our income limits chart, and see if you’re eligible for government assistance.

Learn about the Covered California website. Find easy online enrollment. Set up your account, log in, buy insurance and more on the California health marketplace website.