Stories from the front line: Three major health plans. Three unique challenges.

By Eric Glazer, Vice President, Client Experience & Product Innovation, Teladoc Health

During the most recent AHIP Institute & Expo held in Nashville, three of our health plan clients shared stories of how their organizations are successfully helping members access high quality care and make healthcare decisions with confidence. We are honored to partner with our clients to modernize the healthcare experience and help people resolve their care needs. These stories are ‘bright spots’ that inspire us to continually innovate and collaborate for meaningful impact. Here they are:

1. Helping more members get the mental healthcare they need

BlueCross BlueShield South Carolina (BCBSSC) recognizes the importance of mental health as a key component of overall healthcare. Although an estimated one in five American adults will deal with a medical diagnosis of mental illness, less than half will receive proper treatment. Yet getting members, specifically those in remote and rural communities, to take advantage of available behavioral health resources can be a challenge. Virtual care services break through conventional barriers to mental healthcare by making the process of getting help easy, confidential, and cost-effective. With virtual care, members can speak with a mental health professional whenever and from wherever they feel most comfortable. But simply offering a service like virtual care does not guarantee utilization—it is not a “build it and they will come” kind of thing.

For BCBSSC, Teladoc Health has been a valued partner in driving awareness and adoption of virtual care services by employing proven multitouch engagement methods, and by working with employers to incentivize registration. In their first year, they saw a staggering 22% utilization rate and that number has only grown over the years. In 2018, over 28,000 BCBSSC members were helped by virtual care and in 2019 they saw a 15% increase in behavioral health utilization. With shifts in culture, it is paramount for health plans to stay in front of technological advancement. As millennials enter their thirties and Gen Zers enter the workforce, how health plans deliver care needs to pivot to meet new, highly mobile expectations. With help from Teladoc Health, BCBSSC remains at the forefront of innovation and can deliver convenient, high-quality healthcare, regardless of location.

2. Expanding a trusted relationship by extending a helping hand to a community in crisis

California is home to both a diverse population and geography. Spanning over 900 miles of Pacific coast, California has sprawling metropolises, vast farmlands, and expansive deserts. California is also home to some of the most unforgiving natural disasters in the United States, ranging from devastating floods to ferocious wildfires.

For Blue Shield of California, effectively serving a diverse population of over 2 million members means providing a similarly diverse portfolio of healthcare services. Because they strive to deliver consistent access to high-quality healthcare to all members, they needed to expand our services beyond the traditional brick-and-mortar offices and clinics. That’s why, after a comprehensive search, they chose to partner with Teladoc Health in 2014 and integrate its virtual care offerings into their plan.

In November of 2018, Butte County, California, was ravaged by the most deadly and destructive wildfire in 100 years. The firestorm tore through the region and took with it over 18,000 structures—causing an estimated $16.5 billion in damage. One of the hardest-hit communities was the town of Paradise, and one of the many structures destroyed was the Paradise Medical Group’s primary clinic, which served over 7,000 patients.

With the help of Teladoc Health, Blue Cross of California worked with Paradise Medical Group physicians and staff to reestablish their practice. A customized virtual care network enabled continuity of care for those displaced by the fires, regardless of their health plan. In the wake of this tragedy, Paradise Medical Group was able to quickly stand up a service that helped thousands of neighbors in their time of need. Since then Blue Shield of California has extended their virtual care offering to include behavioral health services, and they are looking forward to providing virtual care to their Medicare and Managed Medicaid populations in 2020.

3. Curbing costs by identifying and reviewing the most complex cases

When they analyzed their spending, Geisinger Health Plan discovered it was paying a disproportionate amount of total costs on a small segment of its covered population with the most-complex cases. This challenge is not unique. According to the American Health Policy Institute, although high-cost claimants make up just 1.2% of the population, they are responsible for an average of 31% of all medical costs.

At Geisinger Health Plan, they focus on three primary goals: serving members, providing the highest quality of care, and managing care costs. But to manage their healthcare spend, they needed a better way to identify and manage their most-complex and highest-cost cases. In 2016 Geisinger Health Plan partnered with Teladoc Health and integrated Expert Medical Services into their plan design. Geisinger Health plan is now able to run algorithms on their data and educate their caregivers on cues to more accurately identify patients who are most likely to benefit from an expert review. Realizing a 2.07:1 return on investment—with an average of $9,500 cost savings per case reviewed, and an average of $46,000 for cases where an unnecessary surgery was avoided, Geisinger Health Plan is also improving outcomes resulting in a 90% member-satisfaction rating.

Due to the overwhelming success of this partnership, Geisinger Health Plan is expanding virtual care to include behavioral health for comorbidities and specialty pharmacy to help curb skyrocketing prescription drug costs.

“Stories from the front line” were originally presented at the AHIP Institute & Expo in Nashville, Tenn., on June 20, 2019.