Blue Shield Creates “Trio” ACO Plan to Compete with Kaiser Permanente

Posted: July 25, 2016

by John Hansen

Blue Shield of California calls the new plan “Trio”. This will be an ACO plan. ACO stands for Accountable Care Organization. This health benefits package will operate much like an HMO, and it might even be labeled an HMO. Top Blue Shield representatives said they were unsure at this time whether or not it would get the HMO label. However, they seemed certain that this plan would help them compete with California’s top HMO, Kaiser Permanente.

The Trio ACO plan will have a Primary Care Physician (PCP). This PCP will act as “gatekeeper”, just like on a typical HMO. A health plan member will need to see their doctor first and then get a referral in order to see a specialist. That means the California health insurance plan gets to do more babysitting, and they can make sure their clients get their checkups and labs done.

The Goal: Compete with Kaiser Permanente in the Managed Care Market

Blue Shield expects to offer comparable or even better pricing than Kaiser Permanente with their Trio ACO plan product line. They will include competitively priced options on all metallic plans including Bronze, Silver, Gold and Platinum. They will also include the “Shield Concierge”, which will give a one-stop-shop experience like Kaiser Permanente.

Blue Shield has done their homework. They know why people like Kaiser Permanente, and they are targeting all the top selling points of the HMO in order to compete.

Also, Blue Shield may beat out Kaiser Permanente in two areas:

• Network: Blue Shield has a much larger network than Kaiser Permanente. That means more doctors available for members on the Trio ACO plans.

• Price: Blue Shield thinks they may be able to beat Kaiser Permanente on price.

If Blue Shield of California is able to offer a cheaper, comparable ACO plan with a larger network, they may be able to compete with Kaiser Permanente or even take market share away from California’s HMO powerhouse.