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Blue Shield outlines TRIO HMO rollout, automatic-enrollment rules and member outreach
Summary
Blue Shield presented its communications and enrollment plan for the TRIO HMO effective Jan. 1, 2018, including targeted letters, phone outreach and informational sessions; board members raised concerns about hospital access (Dignity vs Sutter) and religious directives for some Dignity facilities.
Blue Shield account managers told the Health Service Board they will begin targeted outreach and informational meetings to prepare members for the TRIO HMO launch on Jan. 1, 2018.
Jeanette Moan (Blue Shield) described the communications strategy: customized letters to members depending on whether whole families already use TRIO primary care physicians (PCPs), phone outreach to subscribers with TRIO family members, open-enrollment health fairs, Facebook ads and a Blue Shield microsite. She said those families that are 100% served by TRIO PCPs would be automatically enrolled into TRIO; mixed-family households would not be auto-enrolled and would need to take an affirmative step to change PCPs.
Acting Executive Director Mitchell Griggs and Blue Shield emphasized training for HSS benefit staff to handle caller questions and a plan to monitor call themes and add sessions as needed. Moan and Griggs said targeted materials will include tables showing which hospitals will and will not be in network under TRIO (for example, Dignity hospitals Saint Mary’s and Saint Francis will be in network; many Sutter hospitals will not).
Several commissioners asked about patient access to services typically provided at Sutter hospitals and raised particular concern about Dignity Health’s Ethical and Religious Directives and how that may affect counseling and services (for example, reproductive and end-of-life care). Moan said most of these services are handled in clinics or by referrals outside the hospital and that Blue Shield will include referral and hospital-affiliation information in member letters and at the planned informational sessions.
The board and Blue Shield confirmed that members who do not respond to open-enrollment communications but already have TRIO PCPs may be placed into TRIO; HSS said case-by-case exceptions (for members in active treatment or other exceptional circumstances) will be handled after October 31.
What’s next: Blue Shield and HSS will run targeted phone outreach, post letters and hold informational evening sessions and health-fair support during open enrollment; staff will monitor member questions and report back on enrollment patterns.
