SFHSS details Blue Shield transition plan and outreach as open enrollment nears

San Francisco Health Service System (SFHSS) leaders told the Health Service Board on Sept. 12 that the transition of the SFHSS Medicare Advantage prescription drug (MAPD) PPO administration from UnitedHealthcare to Blue Shield of California is on track but requires extra outreach and manual work to protect members. Ray Guillen, SFHSS chief operating officer, said the change affects roughly 14,500 members and 4,700 dependents and that staff have prioritized member communications and support to limit confusion during the move.

"This transition will be no small feat," Guillen said, summarizing the program’s 30‑day rollout activities and the shared implementation dashboard used by HSS, Blue Shield and Aon. He said the teams have stood up call centers, updated a Blue Shield microsite, held a town hall and sent multiple emails and postcards to members to explain the change and available supports.

Blue Shield and HSS officials highlighted joint metrics they are tracking: inbound and outbound calls, first‑call resolution rates, call handle times and shared dashboard statuses that flag issues as green/blue/yellow/red. Charles Lee of Blue Shield reported fast answer times and strong first‑contact resolution on the Blue Shield side; Olga Stevinskaya Velasquez, HSS operations manager, said HSS first‑contact resolution sat near 88 percent in August for member calls handled directly by HSS.

Board members pressed staff about two implementation risks. First, Guillen described an unresolved data issue with UnitedHealthcare: UHC declined to provide a requested file listing active prescriptions with tier assignments — citing proprietary formulary data — which would have allowed Blue Shield to proactively flag the small share of prescriptions (about 2 percent) that could move to a higher co‑payment tier under the new plan. "They have claimed that it’s proprietary information," Guillen said; HSS and Blue Shield are preparing a plan B that includes targeted mailings and phone support to let members check prescriptions individually.

Second, Guillen explained a short‑term gap for a small group of members who have Medicare Part B only. Blue Shield did not initially have a filed Part B‑only plan for this population; Blue Shield and HSS agreed on a one‑year commercial solution so the approximately 129 impacted members will have equivalent benefits and provider access until a MAPD product can be filed by Jan. 1, 2026.

HSS and Blue Shield emphasized the outreach strategy: a dedicated Blue Shield concierge call center, HSS member services support, direct mail, email updates (open rates reported in the 60–65 percent range for initial mailings), QR‑code callbacks and in‑person town halls. Guillen said staff are monitoring escalations and reported only eight escalations requiring special handling through late August.

Members and board allies praised the communication work. Fred Sanchez, president of Protect Our Benefits, told the board that town halls and mailings substantially reduced retiree anxiety and that the Blue Shield concierge staff had helped individual members resolve medication and benefits questions.

Next steps: HSS will continue to staff a joint implementation team with Blue Shield and Aon, publish updated FAQs and hold additional town halls and webinars through open enrollment. HSS plans to report transition metrics and open‑enrollment results to the board in November and a fuller post‑open‑enrollment update in December.

Provenance: Presentation and Q&A (SEG 1603 — SEG 2630).