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San Francisco board adds Blue Shield's TRIO HMO as optional plan, citing competition and cost savings
Summary
The HSS board voted unanimously to add Blue Shield's TRIO HMO option for the 2018 plan year; Blue Shield and the system's actuary described network differences, a 10% price gap, and a three‑year claims corridor the insurer will cover to limit the trust's exposure.
The San Francisco Health Service Board voted May 18 to add Blue Shield of California's TRIO HMO as an optional plan for employees and early retirees beginning in 2018, a move Blue Shield and board staff described as a step to increase competition and lower costs for many members.
Blue Shield representatives described TRIO as an ACO‑style, higher‑integration HMO that bundles aligned physician groups and hospitals (including Brown & Toland, Hill Physicians, John Muir and Meritage) to reduce unit costs. Paul Brown of Blue Shield told the board TRIO's network and care coordination programs allow the company to offer rates roughly 10 percent below the full AccessPlus HMO for members who use TRIO providers.
Blue Shield and Brown & Toland said the TRIO network would exclude Sutter/CPMC hospital facilities in some geographies; they emphasized that emergency care and physician referrals in medically necessary cases would remain covered, and they described continuity‑of‑care protections for members already in active treatment. To limit the city's financial exposure while the new option takes effect, Aon Hewitt's actuary highlighted a negotiating concession: Blue Shield agreed to absorb claims beyond a narrow 3 percent corridor above the TRIO rate for three years, and the trust maintains a claim stabilization reserve (noted by the actuary as approximately $15 million) to backstop experience.
Commissioners raised concerns about adverse selection: Commissioner Sass and others warned that healthier members could migrate to TRIO and leave a smaller, higher‑cost population in AccessPlus, driving up rates there. Neil Kocher of Aon Hewitt said staff and the insurer would continue monitoring pooled experience and would hold combined rating for the near term while collecting data; the actuary recommended rating the pool together for at least the short term and revisiting segmentation when sufficient experience exists.
Blue Shield outlined an extensive communications and enrollment plan, including targeted mailings and phone outreach to members whose primary‑care relationships make them eligible for TRIO and staffing for post‑enrollment member support. Blue Shield said roughly 70 percent of the HSS membership already see TRIO providers, which the company cited as a reason many members could take advantage of lower contributions without changing physicians.
The board voted to accept the staff recommendation to add TRIO as an option. The roll call recorded the board members present voting in favor: President Scott, Commissioner Breslin, Commissioner Frignio, Commissioner Follinsbee and Commissioner Sass. Staff will provide county/ZIP‑level provider lists, detailed communications and monitoring reports before open enrollment.
