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CalPERS reports implementation issues, improving call metrics after PPO move to Blue Shield and Included Health
Summary
CalPERS staff updated trustees on early operational problems after moving PPO administration to Blue Shield and Included Health, including high call volumes and primary‑care matching issues; staff said service metrics and member navigation are improving and continuity‑of‑care safeguards were implemented.
CalPERS staff told trustees that the multi‑month transition of roughly 400,000 PPO members to Blue Shield of California and Included Health produced early service gaps but is now stabilizing.
Rob Gerzombek, a CalPERS team member, said call volumes to Included Health peaked at about 6,000 calls per day in January, driven largely by members seeking clarification about primary care provider (PCP) assignments. Staff and vendor teams implemented corrective actions — expanded provider network access, additional call‑center agents, a voice mailbox option for PCP changes, improved FAQs and training, and closer quality monitoring — and metrics are improving: Included Health answered 62% of calls within 30 seconds in January–February and has a target of 90%.
CalPERS also established continuity‑of‑care protections and a limited out‑of‑network exception program for members undergoing active treatment, maternity care, scheduled surgery or other specified conditions. As of February, staff reported about 1,100 continuity‑of‑care requests with roughly 950 approvals; about 100 limited out‑of‑network exception requests were received and most were approved.
Service and use so far: Through February, Included Health said it provided over 21,000 referrals to high‑quality providers, enrolled nearly 300 members into care management (about one‑third into the maternity program) and delivered nearly 1,100 virtual primary/urgent care visits and more than 550 virtual behavioral health visits. CalPERS staff said they are monitoring call recordings, reviewing training materials, and improving the Included Health app and navigation so members can more easily find in‑network PCPs and learn about new benefits such as free lab tests and doula coverage.
Trustee questions and next steps: Trustees asked whether language support or other access issues emerged; staff reported no language‑access problems flagged. The committee requested ongoing updates on clinical quality measures and member experience scores as the partnership matures.
