Latest / Becker’s Payer Issues Podcast / Three Years of Virtual Blue and the Future of Virtual First Care at Blue Shield of California

Transcript

Three Years of Virtual Blue and the Future of Virtual First Care at Blue Shield of California · Becker’s Payer Issues Podcast

• 0:00
  Hi, everyone. This is Elizabeth Cassello with the
• 0:02
  Becker's Payer Issues podcast. I'm really excited today
• 0:05
  to be joined by Tim Leeb, senior vice
• 0:08
  president of commercial markets at Blue Shield of
• 0:10
  California.
• 0:11
  Tim, thank you so much for joining us
• 0:13
  today.
• 0:14
  Thank you for having me, Elizabeth. Looking forward
• 0:16
  to the conversation.
• 0:17
  Yeah. Me too. So before we jump into
• 0:19
  things, I would love to hear a little
• 0:20
  bit more about your role at Blue Shield
• 0:22
  of California
• 0:23
  and your background leading up to this role.
• 0:26
  Perfect.
• 0:28
  So as you said, senior vice president commercial
• 0:30
  markets, and what that means for us is
• 0:31
  I have accountability for all of our employer
• 0:35
  groups. Everything from our small group, those under
• 0:38
  a 100, all the way through,
• 0:40
  including our government, private sector,
• 0:43
  municipalities,
• 0:45
  full profit and loss responsibilities
• 0:48
  for those and, thus,
• 0:50
  directly linked to what our products are and
• 0:52
  what our needs are in the marketplace.
• 0:55
  You know, I know you said also what
• 0:56
  was way of background.
• 0:58
  I started in this business from the very
• 1:00
  beginning just as a customer service rep. So
• 1:03
  I've seen everything. And
• 1:06
  what I view is
• 1:08
  from that background of starting there to doing
• 1:11
  consulting to working with other carriers,
• 1:14
  I've really seen the gamut and have a
• 1:16
  comprehensive
• 1:17
  understanding
• 1:18
  around what is it that members need, what
• 1:20
  is it that customers are trying to solve
• 1:22
  for. So, you know,
• 1:25
  it's a it's a long, long history, but
• 1:27
  it's been a joyous ride.
• 1:30
  So today, we're gonna talk about the three
• 1:32
  year anniversary of Virtual Blue, Blue Shield of
• 1:35
  California's
• 1:36
  flagship
• 1:36
  virtual first care program. So maybe before we
• 1:39
  get into some of the numbers, could you
• 1:40
  just tell our listeners
• 1:42
  what Virtual Blue is like and what you're
• 1:45
  striving to do with it?
• 1:46
  Yeah. So
• 1:48
  Virtual Blue is not saying everything has to
• 1:51
  be virtual.
• 1:52
  But what it was doing was saying, what
• 1:54
  would be this virtual first type program that
• 1:57
  members were looking for? So how did we
• 1:59
  have a virtual component with primary care, with
• 2:02
  specialist care?
• 2:04
  But then it was the standard
• 2:06
  brick and mortar
• 2:07
  health care backing that program up. So, really,
• 2:11
  we were delving into
• 2:13
  post COVID
• 2:14
  what was worked from a member's perspective and
• 2:18
  what did we wanna carry forward. And so
• 2:20
  that's what the program was built around is
• 2:22
  what were member preferences.
• 2:25
  So recent data shows a seven to 10%
• 2:28
  lower overall cost of care with Virtual Blue,
• 2:30
  but one really striking figure is more than
• 2:32
  a 30% reduction for high risk members. So
• 2:35
  that equates to $17,280
• 2:38
  per member per year on average. So what's
• 2:41
  actually happening clinically with that population that's driving
• 2:45
  such an outsized result?
• 2:47
  So two main things. It's one, it's how
• 2:50
  that care is being handled and
• 2:53
  that it's a constant connection then with the
• 2:56
  member. So it's very longitudinal
• 2:58
  type view of how we're supporting the member.
• 3:01
  So within that, you have your primary care.
• 3:04
  You have your specialist. They're looking at the
• 3:06
  labs.
• 3:07
  They're really connecting, and it's that comprehensive
• 3:11
  patient record
• 3:12
  of how to treat the member. Now
• 3:15
  everything is it's the early identifier. Right? It's
• 3:18
  three years into the program. This is what
• 3:20
  we're seeing on the results.
• 3:22
  They could grow. They could erode some. But
• 3:25
  what was
• 3:26
  pivotal for us is
• 3:28
  we see
• 3:29
  lower types of care that are really your
• 3:32
  big cost drivers. So when you think about
• 3:34
  some of the higher cost, those with chronic
• 3:37
  conditions,
• 3:38
  They may go to the emergency room or
• 3:40
  they're gonna see different levels of care. They're
• 3:43
  really kinda getting lost in the system.
• 3:45
  And and some this is a program that
• 3:47
  really helps them navigate and always gets them
• 3:49
  to the right care and has the resources
• 3:51
  available.
• 3:53
  So what does utilization
• 3:54
  look like with a virtual first plan? You
• 3:57
  know, thinking we're gonna talk a little bit
• 3:59
  more about the ER side of things. But
• 4:00
  even beyond that, what are you seeing trends
• 4:03
  wise overall?
• 4:05
  I mean, overall, we're seeing greater primary care
• 4:08
  utilization.
• 4:09
  And then even within that,
• 4:11
  that primary care, 85
• 4:13
  of those members are getting a behavioral health
• 4:15
  assessment. So we're seeing shorter, you know,
• 4:20
  time to get to primary care. We're seeing
• 4:23
  shorter time to get to the specialty care.
• 4:25
  So it's really being responsive
• 4:28
  in a world right now where access is
• 4:30
  probably one of our biggest problems. You know,
• 4:33
  we're seeing members really struggling to get access
• 4:36
  to their primary care or to the specialist
• 4:39
  that they need to see.
• 4:41
  So to transition into some of those ER
• 4:43
  numbers, emergency room visits dropped by more than
• 4:46
  ten percent. So can you walk me through
• 4:48
  a real member scenario where Virtual Blue intercepted
• 4:51
  what could have been an ER visit?
• 4:54
  Yeah. I mean,
• 4:55
  a great one is for the person who's
• 4:58
  traveling. Right? For the person who's traveling that
• 5:01
  suddenly
• 5:02
  they're,
• 5:03
  they're at a meeting. Could be just someone
• 5:05
  going down to Southern California.
• 5:07
  They're at a meeting and suddenly,
• 5:10
  they need they're getting sick. They're able to
• 5:12
  call the primary care. They have all the
• 5:14
  information. They have the full clinical record. They
• 5:17
  can prescribe. They can handle.
• 5:19
  But, also, it's for,
• 5:21
  you know, what about the school teacher? Those
• 5:24
  that are more on a program where
• 5:27
  they need a different level of access. So
• 5:29
  how do they get the care, or how
• 5:31
  do they get that visit for their child
• 5:33
  or for themselves?
• 5:34
  And so it really makes sure that it
• 5:37
  meets the needs of when someone can actually
• 5:41
  make that virtual visit, which an in person
• 5:44
  might visit might have been so difficult for
• 5:46
  them to actually get to or would have
• 5:48
  taken they would have had to take time
• 5:50
  off to get that visit.
• 5:53
  So what have sales conversations looked like with
• 5:55
  employers from when you first launched this product
• 5:58
  to today? And, also, what have what does
• 6:00
  the dialogue with providers look like when it
• 6:02
  comes to this offering?
• 6:04
  So first, what is that sales dialogue? Right?
• 6:08
  Early on, it was all about education.
• 6:10
  It was all about, like, how would this
• 6:12
  program it was really answering probably more the
• 6:15
  questions of, wait. So is this virtual only?
• 6:19
  It was really trying to say, how does
• 6:21
  it all work, and how is it again
• 6:23
  something that
• 6:24
  we saw as a members wanted that type
• 6:27
  of program?
• 6:28
  So so that was one in the beginning.
• 6:31
  You know, where it became was it almost
• 6:33
  became less and less about, let me just
• 6:36
  educate you on this virtual blue product too.
• 6:39
  Well, could I have that in these other
• 6:41
  programs? So, like, customers already were going to
• 6:44
  they were designing. Right? They were saying, what
• 6:47
  do I want, and how would I love
• 6:49
  to see the program morph and and really
• 6:51
  adapt to what they saw as their needs?
• 6:54
  So it
• 6:56
  it's usually as a slice type program. You
• 6:58
  know, this isn't for every member. We know
• 7:00
  that. So it's always like talking to the
• 7:02
  customer about how this is a fit for
• 7:05
  what they're looking for.
• 7:07
  Relative to other providers, I think it's mixed.
• 7:10
  Right? I'll just be transparent. I think, you
• 7:13
  know, when we're putting it in and and,
• 7:15
  you know, we're looking at it in
• 7:17
  our our models that have capitation,
• 7:19
  there's always a question to say, wait. How
• 7:22
  are they gonna see a member versus what
• 7:24
  will I see?
• 7:26
  But
• 7:27
  in a in a PPO model,
• 7:29
  it really is a compliment. Right? It doesn't
• 7:32
  really take away from what's there. It really
• 7:36
  forms as how providers then see it as
• 7:40
  it's really a a conduit
• 7:42
  of how they're gonna also see members. And,
• 7:45
  really, it's filling gaps that they can't meet
• 7:48
  at this point in time.
• 7:51
  So I'd love to hear you're now adding
• 7:53
  virtual primary care to the Trio HMO plan
• 7:56
  for individuals.
• 7:57
  So what were some learnings from the employer
• 7:59
  group experience that you're now translating to the
• 8:02
  individual market?
• 8:04
  I mean, if it's simple,
• 8:07
  intuitive,
• 8:08
  you know, it works. Right? So that zero
• 8:11
  co pay was something that
• 8:14
  we recognized.
• 8:15
  While it doesn't have to be zero, it
• 8:17
  has to be a simple co pay structure.
• 8:19
  It has to really remove the barriers, and
• 8:22
  that's what we saw.
• 8:24
  The better our messaging can be about what
• 8:27
  the program is and how it works,
• 8:30
  it helps a ton. And the last item
• 8:33
  that really
• 8:34
  was a learning is
• 8:37
  when we can engage them in that level
• 8:39
  of virtual care,
• 8:41
  it's easier to do the follow-up. It's easier
• 8:43
  to keep them connected
• 8:45
  and to make sure we're gonna be able
• 8:48
  to catch if it's a chronic condition or
• 8:50
  if it's getting them to the lab.
• 8:52
  It's because, again, we still may be sending
• 8:54
  them to the lab, but it's easier. Right?
• 8:56
  They didn't have to do that initial visit
• 8:58
  to then get to the lab.
• 9:00
  It wasn't a I had to run around.
• 9:02
  It's very straightforward.
• 9:04
  And so what we have learned is
• 9:08
  through Virtual Blue, we really got a good
• 9:10
  sense of what we could do with it
• 9:11
  and then to start building within our other
• 9:14
  programs
• 9:15
  to see how it can actually
• 9:17
  further reduce cost and really create greater access
• 9:21
  for members.
• 9:22
  One other thing that came up when I
• 9:24
  was reading the release about the three year
• 9:26
  anniversary was expansion to rural areas and health
• 9:30
  professional shortage areas as well as supporting members
• 9:33
  during wildfires. So what's the story from on
• 9:35
  the ground
• 9:36
  that illustrates why virtual first matters in those
• 9:39
  contexts in a way that maybe traditional telehealth
• 9:42
  that's acting more supplementally
• 9:44
  might struggle with? Yeah. I mean, it's so
• 9:46
  funny because this is the one where I
• 9:48
  really get excited, Elizabeth, because, you know, I
• 9:50
  grew up in a really small town.
• 9:53
  And I remember we had to drive thirty
• 9:55
  minutes to get to the provider, right, to
• 9:57
  get to any of the doctors.
• 9:59
  So virtual blue eliminates that. It's you can
• 10:03
  have the access.
• 10:04
  You have the ability to have that provider
• 10:07
  visit right from your home. It's not about
• 10:09
  driving thirty minutes to even get to
• 10:12
  a provider.
• 10:13
  But then in a in a case of
• 10:16
  an emergency, right, where the roads might be
• 10:18
  challenged or there are other issues, you could
• 10:21
  have that visit. So during the wildfires, maybe
• 10:24
  you couldn't get to your provider, but then
• 10:26
  how would we still get a prescription or
• 10:28
  what would be needed? So
• 10:30
  it's the level of comprehensive
• 10:32
  care
• 10:33
  that you can get in a virtual setting
• 10:36
  that it has really empowered our general thinking
• 10:39
  about what do we need to, again, deliver
• 10:41
  for our members. It's it's really challenged
• 10:45
  how we think about care.
• 10:47
  And just as importantly, I think it's
• 10:50
  really delivered what, again, members were were needing
• 10:54
  and the ability to create and have that
• 10:57
  primary care relationship,
• 10:59
  but not having to travel
• 11:01
  is a welcome item for our members.
• 11:04
  What do you think is next for Virtual
• 11:06
  Blue over the next three years?
• 11:09
  Wait.
• 11:10
  I just I just see it as it's
• 11:12
  gonna be such a component of so many
• 11:15
  of our programs, and it's making us rethink
• 11:18
  virtual care in general. I think it'll it
• 11:20
  might shift how a number of the providers
• 11:23
  actually deliver virtual care themselves around what they
• 11:26
  enable virtual, what they do brick and mortar.
• 11:29
  But
• 11:30
  for me, it's it's making
• 11:33
  sure we are really thinking about the member.
• 11:36
  And so it's less about, like, what is
• 11:40
  a product for it might be easy to
• 11:44
  administer.
• 11:45
  It's more of a, but what is the
• 11:47
  member need? And to me, it's really bridging
• 11:50
  that gap
• 11:52
  of connecting more and more to how they
• 11:55
  wanna engage, to what other services they may
• 11:58
  need. So it'll be the expansion of virtual
• 12:00
  blue, but then it's gonna be what else
• 12:03
  what other services do we make available virtual?
• 12:06
  How do we then think about
• 12:08
  between pharmacy delivery and everything else to the
• 12:11
  member because of how they wanna interact with
• 12:15
  the health care system.
• 12:17
  Do you have any final thoughts for industry
• 12:19
  leaders who may be weighing virtual first products
• 12:22
  or are just kind of toying with that
• 12:24
  space?
• 12:26
  I mean, I would simply say
• 12:29
  embrace it and understand
• 12:32
  it's not for every member, but it is
• 12:34
  the way so many members wanna engage. And
• 12:37
  so how do we really begin to think
• 12:39
  about
• 12:41
  helping to support them? Because overall, like,
• 12:44
  in our current society,
• 12:46
  about 90%
• 12:47
  of all health care costs are being driven
• 12:49
  by chronic care or chronic conditions.
• 12:52
  And if you think about that level
• 12:55
  of chronic conditions that are out there, we
• 12:58
  have to be thinking about different ways to
• 13:00
  engage them, to make sure they're getting the
• 13:02
  care,
• 13:03
  to help drive down costs,
• 13:05
  and create better outcomes for
• 13:08
  our our society.
• 13:09
  And
• 13:10
  it means
• 13:11
  thinking differently about how care is being rendered
• 13:15
  and just as importantly,
• 13:17
  how they wanna engage.
• 13:19
  Well, Tim, thank you so much for joining
• 13:20
  us today.
• 13:22
  Thank you so much, Elizabeth, for having me.
• 13:25
  Of course. And to our listeners, if you'd
• 13:27
  like to listen to more podcasts from Becker's
• 13:29
  Healthcare, you can visit beckershospitalreview.com.