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

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