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Board hears pilot for advanced primary care model led by PBGH, Altais and Blue Shield
Summary
PBGH, Altais and Blue Shield outlined a pilot for 'advanced primary care' that expands care teams, integrates behavioral health, uses virtual scribe technology, and measures performance against national benchmarks; SFHSS will monitor outcomes and consider scaling to additional practices.
A coalition led by Purchaser Business Group on Health (PBGH), provider group Altais and Blue Shield of California presented an advanced primary care pilot to the SFHSS board on Sept. 12 that aims to expand team‑based primary care and measure outcomes for SFHSS members.
"We are looking not just for investing in primary care, but investing in primary care that ensures access that is timely," Raymond Tsai, PBGH’s vice president for Advanced Primary Care, told the board. Tsai described the Care Excellence designation that sets standards for access, integrated behavioral health, data‑driven measurement, and health equity. The pilot launched in January 2024 and initially includes five Bay Area practices, some of which operate under the BT Health name.
Tricia Nagoon of Altais described operational changes inside participating clinics: expanded care teams that include social workers, behavioral health care managers, pharmacists and dietitians; pre‑visit planning and post‑visit follow‑up; and a virtual scribe product to reduce clinician documentation burden. "The virtual scribe has been a tremendous time saver, more than an hour a day," she said, saying the technology helps clinicians spend more clinical time with patients.
Nina Birnbaum, Blue Shield’s medical director for innovation, said the payer role includes enabling value‑based payments, reducing administrative burden, and supporting provider enablement. Presenters said primary care performance across many measures exceeded the 66th percentile national benchmark, with remaining gaps for asthma control and blood pressure control being addressed through manual pharmacy outreach and care management workflows.
Board members asked whether the pilot could scale beyond Northern California and whether metrics measured prevalence or control rates; presenters said the current work is a pilot intended to scale nationally if it proves effective and clarified that the measures indicate control/outcomes rather than prevalence.
Next steps: the board invited the team to return after the initial assessment period to report early learning and adjustments. SFHSS staff said they will monitor performance guarantees and consider alignment with the California Advanced Primary Care Initiative in contracting and plan management.
Provenance: Presentation and Q&A (SEG 750 — SEG 1540).
