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TRIO, Blue Shield’s HMO Aimed at Competing with Kaiser Permanente

by John Hansen

Blue Shield Covered California aims at competing with Covered California Kaiser PlansTRIO is Blue Shield of California’s aim at providing an affordable, high quality managed care product. It is an HMO, so the primary care physician (PCP) serves as the gateway to specialists in an effort to lower costs.

Blue Shield Covered California aims to get every patient to do an initial visit with their PCP to get their checkups. Or, as Renee Casserly, Director of Sales Operations and Business Development at Blue Shield of California, says “to get their tires checked.”

With the TRIO product, Blue Shield expects to compete with Kaiser Permanente. Top officials at Blue Shield fully admit that Kaiser is doing a lot right. They understand that Covered California Kaiser plans have a strong brand, and they are looking to similarly build a strong, trustworthy brand.

Kaiser Permanente’s One-Stop-Shop

Kaiser Permanente’s integrative model with their one-stop shop with doctors, specialists, etc. all under one roof has been very appealing to many Californians. Many consumers in the state have gotten to the point where they will not consider any carrier other than Kaiser Permanente.

However, Blue Shield knows that there still are many in the market who do not want to be “trapped” in the Kaiser Permanente system. They want “choice”, and that is where Blue Shield is strong.

However, with the TRIO Product they are really working at competing on price, quality of care and convenience. The nightmare stories of Anthem Blue Cross Covered California and Blue Shield members going through all kinds of frustrating red tape are almost cliché.

My good friend, Abby, said recently, “I miss Kaiser.” Her husband’s work stopped offering Kaiser Permanente, so she had to go with another carrier, and she said it was so much more difficult. She told her horror story about finding a doctor and then having to find a specialist. And, you have to make sure the specialist gets the medical records from the doctor. It was just one headache after another.

These are headaches that perhaps you are used to if you aren’t a Kaiser member. But Abby wasn’t used to them, and she didn’t appreciate them. You can tell her all day long, “Now she has CHOICE!” But, she’s never going to be happy about it. She wants convenience.

“Concierge” Helps Blue Shield Compete on Convenience

Toward this end of convenience, Blue Shield is trying to create a virtual integration of care through their “Concierge”. Members can call the Blue Shield concierge and speak to a high quality customer service representative. They are easy to get a hold of. Celia Gonzalez, of Blue Shield, said that when she called, a live person picked up in “3 to 4 rings”.

The representatives at concierge are very helpful. Gonzalez said, “They found me a doctor 5-10 minutes from my work and helped me with all I needed.”

Concierge is able to push through referrals. They can make appointments with specialists right there over the phone. If you have complications with your prescription drugs, they can help you with that as well. The goal of Concierge is to help give Blue Shield members coordination of all their care in a way that is somewhat similar to Kaiser Permanente.

But what about medical records?

I asked Celia Gonzales if coordination of care included the integration of medical records. It can be a bit frustrating outside of Kaiser Permanente because doctors, specialists, etc. have no idea what’s going on with a person’s overall healthcare. The left hand doesn’t know what the right hand is doing. Also, the task of transporting and communicating the contents of medical records often falls on the patient, who can find this overwhelming.

The short answer to the question about integration of medical records is “NO”. The long answer is that Blue Shield is hopeful that they may be able to accomplish this in the next few years.

Jeff Smith, Blue Shield Individual and Family Plan General Manager, commented about a medical records repository in this state called “Cal INDEX”. He said, “All medical records are getting housed in this one depository statewide.” Currently, Cal Index includes the medical records of over 16 million individuals and has participation from 150 provider partners.

Cal Index could one day allow for carriers like Blue Shield of California to make medical records available digitally to all the doctors and specialists in their networks. “Your records could follow you whether you go to Anthem, Shield, Health Net, etc.,” said Jeff Smith, Blue Shield CA Individual and Family Plan General Manager.

However, he said that implementation of using Calindex for this purpose is still a few years off. Likely, the biggest hold up is the security concerns of opening up such a huge repository of PHI (peronal health information) to a wider group of people, even if those people happen to be medical professionals.

In 2016, Blue Shield was the leading seller of individual plans on the California Exchange. However, in 2017, Kaiser Permanente was #1.

Blue Shield’s hope is that their “Concierge” plus integrated Cal Index medical records and the attraction of choice may allow Blue Shield to stay competitive with Kaiser Permanente, California’s HMO giant.