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HSS board pushes member notice after heated debate over Cal Index clinical data sharing
Summary
After extensive public and commissioner concern about Cal Index/Calendex sharing member clinical data via an opt‑out model, the Health Service System board directed staff to draft a member notice and asked Blue Shield to cover mailing costs. Public commenters and some commissioners called for opt‑in consent and clearer outreach.
President Scott opened a lengthy public discussion on Cal Index (Calendex), a California integrated clinical data exchange that Blue Shield and Anthem helped found in 2014. Blue Shield and Calendex representatives said the system collects clinically relevant, non‑financial claim and clinical data to create a longitudinal patient record intended to support emergency care, care coordination and limited research. Diamond Jones of Blue Shield described scenarios—such as an autistic patient in an emergency department—where rapid access to clinical history could materially change care.
Several commissioners, retiree representatives and union speakers pushed back sharply over process and consent. Commissioners and public speakers said Blue Shield began transmitting member data into Calendex under an opt‑out model without broadly notifying members through the board or getting prior HSS sign‑off on member communications. Retiree groups and unions said members had not understood the scope of the sharing and urged either opt‑in consent or much stronger outreach. Union and public commenters also raised ongoing legal and transparency concerns tied to Sutter and to provider pricing.
Calendex’s chief privacy officer, Andrea Lieb, and other Calendex representatives told the board that (1) the entity is a not‑for‑profit mutual benefit corporation with an independent board; (2) financial data were intentionally excluded; (3) participation agreements and HIPAA business‑associate rules limit uses; (4) opt‑out members are blocked from access and research use per the participation agreements; and (5) patient access to a longitudinal patient record currently occurs via requests to a covered entity (health plan or provider), not directly from Calendex, because of authentication requirements.
After extended public comment and commissioner discussion about notice, accessibility of the opt‑out process and whether opt‑out records remain stored, the board directed the executive director to draft a plain‑language communication to HSS members about Calendex and the opt‑out choices. Commissioners also asked staff to include this information in electronic member communications. The board requested that Blue Shield be asked to fund the cost of any mailed notices once the HSS letter is finalized. The motion to draft the letter and seek Blue Shield payment was seconded and approved by voice vote.
The board did not take final regulatory action on Calendex itself; instead it asked staff to draft the notice and return materials that explain opt‑out mechanics and any implications for retirees and Medicare participants. The board emphasized it expects clearer member outreach and follow‑up reporting on response rates and technical issues with the opt‑out portal.
