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SFHSS staff and Blue Shield outline Medicare Advantage PPO transition, staff says cards due in late December
Summary
SFHSS and Blue Shield told the Health Service Board they expect to transfer roughly 18,500 Medicare and 1,500 non‑Medicare members to a Blue Shield MAPD PPO effective Jan. 1, 2025; staff reported town halls, webinars and a work‑around for an outstanding electronic enrollment file risk and said ID cards will be mailed in late December.
San Francisco Health Service System staff and Blue Shield of California representatives told the Health Service Board they expect a largely smooth transition of the SFHSS Medicare Advantage PPO plan from UnitedHealthcare to Blue Shield on Jan. 1, 2025.
Ray Guillen, SFHSS chief operating officer, said the transition plan covers the administrative and member‑experience work streams needed to transfer approximately 18,500 Medicare members and 1,500 non‑Medicare members from UnitedHealthcare to Blue Shield. "A planned transition of this type requires a lot of setup... many of these items needed to be completed prior to the start of open enrollment," Guillen said.
Olga Stevanskaya Velasquez, HSS operations manager, reviewed member engagement activities: in‑person and virtual town halls with retiree groups and three dedicated webinars; call center support and a direct connect to a Blue Shield concierge line. She said first‑contact resolution for transition issues rose from 91% pre‑open enrollment to 94% during open enrollment.
Blue Shield's Tiffany Gill acknowledged two operational risks that had been tracked: the electronic enrollment file used to transfer enrollments (still requiring work but with a manual workaround to ensure members are in the system), and earlier concerns about medical authorization transfers. Gill said Blue Shield will accept existing UnitedHealthcare authorizations so members need not take action.
During public comment, retiree representative Dennis Krueger asked when members will receive ID and pharmacy cards. Gill said Blue Shield was "on track to get identification cards out to the members the last two weeks in December," so members should have cards before Jan. 1.
SFHSS staff said they will monitor the transition and build a scorecard with Aon to benchmark care, preventive screening and pharmacy adherence against prior performance under UnitedHealthcare.
