Vendors and carriers outline new care‑coordination tools as San Francisco board presses for measurable outcomes

Aon and three contracted health plans told the San Francisco Health Service System Board that new care‑coordination tools could improve member experience — but commissioners pressed for evidence and operational detail.

Neil Mills, Aon’s national medical director, framed the market shift as a move from narrow disease management to holistic population health and urged a mix of digital and live navigation to reach members. He told the board these programs aim to identify cohorts and apply targeted interventions at the “lowest necessary cost” and to expand beyond high‑cost claimant management to broader, proactive support.

Why it matters: Commissioners and staff said better navigation could reduce surprise bills and unnecessary care, but they also challenged vendors to show pilots, independent validation and measurable outcomes before the city scales any solution.

Blue Shield of California described an integrated program launched Jan. 1, 2019 that bundles clinical nurses, social workers and health coaches into a single care model. “We redesigned the whole program and launched it 01/01/2019,” said Shawn Levering, Blue Shield’s account management lead for the City and County of San Francisco. Blue Shield said it operates two tracks: a data‑driven SHIELD Support for AccessPlus members and a white‑glove SHIELD Concierge for Trio members with co‑located clinicians who maintain the case from start to finish. Levering said Blue Shield offers reporting and performance guarantees tied to engagement metrics.

Kaiser Permanente emphasized team‑based care and electronic medical record integration. “At Kaiser Permanente we take a team based approach to care coordination where we're able to then provide the right care at the right time,” said Debbie McConathy of Kaiser. Kaiser described embedded behavioral health clinicians, proactive outreach driven by electronic prompts and online tools that allow members to book appointments, message providers and access a cost estimator.

UnitedHealthcare outlined a nurse‑led ‘‘Advocate for Me’’ enhancement and decision‑support tools for members facing complex choices; the carrier described a 100% outreach approach to identified risk categories and nurse advocates who support members through care decisions.

Board concerns and member experience: Commissioners repeatedly asked how plans identify the highest‑need members and prioritize outreach so limited resources reach those most likely to benefit. Aon and the plans said they use claims, utilization and risk scores to stratify members and that many programs begin by targeting the top percentiles of utilizers. Commissioners asked for clearer stratification logic and for evidence from pilots; Aon said some vendors will accept performance guarantees and that independent actuarial validation is available.

Public comments from long‑time plan members highlighted access gaps: multiple speakers said Kaiser and others sometimes fail to provide timely post‑hospital outreach or make digital tools easy to use. Diane Ehrlich of the UESF Retired Division said her husband had multiple emergency visits and she had to initiate follow‑up rather than receive outreach.

What’s next: Carriers agreed to provide annual reporting on performance guarantees and engagement metrics. Board members requested further detail on stratification criteria, cultural sensitivity training for contact center staff and clearer guidance so members can reliably access care‑coordination services.

The board did not take a vote on contracting or changes to vendor scope during the presentation; the discussion will inform the board’s oversight and future vendor performance reporting.