>> board secretary, we have 8 callers on the phone line, zero callers entered the queue at this time. >> thank you moderator. hearing no callers, public comment is now closed. >> thank you. next agenda item, please. >> item 13, blue shield of california medicare advantage prescription drug, mapd ppo transition plan. this is discussion item and presented by rey guillen, sfhss chief operation officer, olga stavinskaya-velasquez, operation manager, tiffany gill, blue shield of california major account executive and charles lee, the blue shield of california manager of group retiree senior markets. >> great. good afternoon again commissioners. rey guillen, chief operating officer for health service system. as secretary lopez mentioned, i will be joined by some esteemed colleagues from

internal to the organization olga, the operation manager and also some representatives from blue shield and together we will walk you through the joint transition plan for the blue shield medicare advantage preferred provider organization plan. today i will begin with a short background and outline of the key objectives we are using for our planning. introduce the experienced team we have assembled to assist with the transition. then olga along with tiffany and charles from blue shield will walk low the transition plan details. taking time to highlight blue shield's tasks and those assigned to the h is ss team. highlight the metric tracks along the way to verify we are on the path to success and by the conclusion of our presentation today, our goal is to have assured you that we got this.

we are very confident all existing members will be enrolled in the blue shield plan come january 1, and that effective january 1, there wont be any empedements to the care that our members are acustom to. as you are aware june this year, this board approved the blue shield ppo plan to replace the existing united healthcare plan effective january 1, 2025. the benefits of the new blue shield plan match the existing uhc plan and the plan provides the same access to all the doctors and healthcare providers that accept medicare just like our existing uhc plan. however, we do know that this type of change can be stressful to our members and simply because of the fact that basic healthcare is one of the primary

basic needs of every individual and so we are going to be make sure very sure that we have informed our members of the information that they need so that they can transfer over to the new plan without any impedement to that care. on the screen are the two main objective we set for this transition. first, we are taking every available step to make this a smooth and easy transition for our members. second, with every opportunity presented, we are efforting to anticipate and address any concerns our members may have in order to assure them that they will continue to receive the comprehensive and excellent care that they are acustom to. to insure the success, we

assembled a experienced and capable team to both design and implement this joint transition plan. this team includes staff from both hss and blue shield, plus we have leveraged subject matter experts from hss actuary and benefit consultant, aon reviewing all aspects of our plan and communication materials to confirm woe are following best practice. aon will test and assess blue shield claim and operation al system to insure they are set up correctly and match all commitments that were made in the blue shield proposal. so, to iterate, the key elements for our joint transition plan include, a continuous effort to assure our members through excellent customer support both from hss and blue shield teams and

proactive communication. in addition, we will be leveraging internal and external expertise available to us and also build upon prast transition experience, including our non-medicare ppo plan transition michael went through that happened for plan year 2022, and the split medicare family transition that we went through for plan year 2023. in addition, we will support each individual member as a individual with their own unique needs and concerns, but focus on the fact this is the same ppo plan design with open access to all medical providers nation wide who accept medicare with the same benefit and copayments that currently are enjoyed under the existing uhc plan. finally, we are going to insure all our processes and systems are set up and ready to go so that our members only experience a smooth transition.

so, i'll turn it over to tiffany gill from blue shield to walk through the specific blue shield component of the transition plan. >> thank you. tiffany gill, blue shield of california. good afternoon. i wanted to just let know about blue shield. there are new commissioners and wanted to make sure that everyone was familiar with blue shield. we are a tax paying non profit healthcare company that headquartered in the bay area, and our mission is to provide and create a healthcare system that is worthy of our family and friends and sustainably affordable. we believe in operating with transparency and efficiency and are these are the tenants that will get us to our mission. we also are building a diverse

workforce that mirrors our members. we want to make sure that all of the details and plans that and programs we put into place come from a diverse workforce that understands those programs and plans and healthcare needs of all our members in california and nation wide. our mission also i believe aligns very closely with the sfh ss strategic plan, specifically where we are affordable and sustainable healthcare. the supporting the primary care, and also making sure that we have excellent customer service. fwr example, we actually have increased our supporting our physicians with different programs in helping them with achieving their goals with

member satisfaction, and patient quality. in doing that, and the programs we put in place 2022, we were able to increase what we call, we have a net promoter score for our physicians, which is just basically a satisfaction measurement, and we increased by 21 points in 2022 to 44 net promoter score, which is actually impressive seeing as most of the healthcare industry average is at around 27 points. we definitely appreciate the opportunity that you have to serve the medicare eligible retirees, just as we have the active employees, the members that are under age 65 that are retired as well. i have been around long enough to be able to know i can't stand up here and say i'm going to guarantee there isn't going to be questions or issues or comments that are going to come

from this implementation, but what i can promise is that we will immediately act on any concerns, any questions, any issues that arise. i have a full team that will be helping me and we are assessing and anticipating any questions and needs that come up and in terms of communications and any member services types of questions that come through. with that, i actually want to introduce charles lee who is our blue shield senior manager of group retiree and senior markets. he is going to be standing and has already been standing side by side with me and will be helping anticipate and help with any of your member needs. >> thanks tiffany.

charles lee, medicare group retiree service, senior manager. we realize obviously there are a lot of questions and concerns from the membership, so we have actually set up already a soft launch with a blue shield dedicating model, member services. the number is live right now, 800-370-8842. we are already answering questions and concerns about the upcoming plan. >> my paper says 8852. is it 52 or 42. >> 8852. sorry, i misread that. thank you commissioner. so, our member service staff are going to be dedicated to the hss population and familiar with the plan and understand the needs. they actually reviewed quite a few of the board meetings and understand the

concerns and so we absolutely are ready to answer any and all questions. along with the member service, we also have access to additional experts and resources, such as registered nurses, pharmacists, health coaches, pharmacy technologist, social workers and dieticians as well. so, we've got a variety of resources available to on staff on the phone to be able to address a variety of questions and a variety of issues. these folks are available 7 days a week, 8 to 8, the only holidays are thanksgiving and christmas. in addition to these experts andf sta, we also have a subset of care navigators. with our experience recently, we noticed that getting appointment has been a challenge for folks with the capacity with folks getting

back from covid, so we have a specific set of folks that their role is to help gain access and be able to with appointment scheduling and care coordination. all these folks to assure you have been hand selected to support hss. to be frank, these are the best of the best. to insure that communication is clear, honest, courageous and we are able to meet the needs and expectations of our members. we want to work in partnership with hss with the members and with our staff to be able to provide the best care available. and, continuing with our partnership montra, i think olga will continue on with our partnership efforts with hss. >> can we know why we are only

available to 1 p.m.? >> commissioner zvanski, is that for in-person support? >> right, in-person support. >> right now the health service system in-person support is open from 9 to 1 for our members for in-person support. due to the low staffing we experienced last year, we still haven't transitioned to fully opening the in-person center that we have, but we have been available during the timeframes and been twracking the number of members that do utilize the services both to come in for full support and for drop in support and we have not seen a large increase other then during open enrollment last year. it is based on the needs of our members, and our capacity. >> okay. and we are not getting

complaints or members calling saying, i tried to get access and couldn't, it wasn't open late enough? >> we tried to help them if they are coming in. we are doing our best to be able to help them in person as well, but our call center itself is actually open from 9 to 5 every day, so accept for thursdays it is 10 to 5. we are still open and available as a resource during the hours for calls, correct. >> just wanted to confirm that. thank you very much. appreciate it. >> so, operation manager with health service system. the operation team has been working closely with blue shield implementation team to insure a smooth transition for our members and handle increased capacity and phone callss that is a result of the transition. a way of background last year at this

time, my team member service division was at 50 percent staffing so to [indiscernible] open enrollment we engaged in personal service contract with vsa, a off site call center group to be able to support all our members that are calling during the open enrollment time period. this year we again anticipate that high volume of callers, again due to open enrollment and of course due to the transition that will be happening to the blue shield ppo plan and very excited to say that we are fully staffed at member services and ready to be able to support our members, but we'll continue to engage with vsa for that off-site call center support and to be able to handle any sort of overflow in phone calls that may be originating due to the transition. and with our partnership with blue shield, we want to make sure that any of the transitioning members

have that approach to the services they are seeking and i know executive yant mentioned the soft launch. we have been testing the readiness of the service by engaging several retirees to test how their experience is with calling the call center, utilizing the website. this week has been very heavy in myself and some of my team members calling those members to engage them and see whether they are willing to par tace pate and get the early start getting the transition happening for them. we had a couple of folks respond already. they had really great feedback, especially around the website and overall their feedback on the customer service level has been quite positive. and has been mentioned, we are open for in-person, so call center support isn't

the only way for members to reach out. our lobby is open and one of the other features we will have in supporting the transitioning members is having a blue shield representative in our lobby during our business hours, so that would allow for those members more comfortable having the one on one in-person approach to have the opportunity there as well. we have been working with blue shield our vsa partners on staff training, making sure all our teams are ready and prepared to support this population. the transitioning population and open enrollment overall. the major focus of all the training has been on customer service. and in the next two slides, you will see the set up we developed with no

wrong door approach. our goal is to insure our members have a first contact resolution experience. member services team from sfhss along with vsa team will continue to support our members with the general open enrollment questions, support and making changes that are applicable for open enrollment, but we will have the soft hand off approach to the blue shield team to the team when questions very specific around the members plan inquiries, especially around navigation of services and transition of care or support with provider access, when those kinds of questions are asked, we want to make sure that hand-off is smooth to the blue shield team and as we go through the warm transfer process to our counterparts in blue

shield, we will continue to insure that the level of service that is provided to the members is that first contract resolution. we want to make sure when the member comes off the phone with either our team or the blue shield team, they have the answer they are looking for. we do note that there may be situation wheres call-back may be required. as a example, in planning out the support that both teams will be providing, when members are calling to insure their provider is going to continue to be their provider under the blue shield plan, this may require a call-back for the member, because what we've identified is some providers may need some education on medicare billing, and so the blue team-blue shield team is dedicated to doing outreach to providers going over medicare billing and connectic bag with members to insure they get

resolution for their inquiry. additionally, the escalation process we established for our members, because there may be issues that come up, we want to make sure we have that set up as well. all these things have been thought through and planned out. teams trained and confident to be able to handle this transition. we've--in the next slide, between the two slides you can see the escalation and the transfer process between both the blue shield and the uhc team so there is always that confidence that the member when they get off the phone with us are either going to have their answer, or know somebody is going to be calling them back directly with a answer upcoming. >> what does warm transfer mean? >> so, warm transfer is generally when a one agent transfers a call to

another agent without leaving the member to kind of reexplain the full situation to the new agent they will be speaking with. we give a little bit more of the information to the agent before connecting the member to the blue shield side. >> thank you. >> my understanding is that we'll have a team of 20 or so blue shield staff with opportunity for 20 more, 26 more for any overflow calls. as you can see, the volume of agents that will be available for calls to be answered is going to be quite high. i will go ahead and transition to blue shield plan highlights. >> thanks olga. charles lee, medicare group retiree. as olga mentioned and to clarify a feature of warm transfer. it is so the member doesn't have to call back or make another call. it is so they are transferred

between a couple teams to be able to assure their questions are answered in a timely manner and so that they don't have to get back into a queue. we actually got a great system in which we can call each other through back channels and get to the head of the queue and support members in a timely manner. as mentioned, we got 20 blue shield members or service folks available along with 36 overflow capacity as well. we are going to get this. we got this. i will move forward to the blue shield plan--shoot. we are back here. this slide is to help reiterate and emphasize the key features of

the new plan. as you notice, it is very similar to the current plan and that's by design of course. one key features that we maintained is the access to same network of providers that folks are using today, and through the blue shield network and through the medicare participating network. i'll talk about that in a up couple slides. we also have joint copay and coinsurance with rich formulary to minimize disruption. we also got additional benefits and not limited to annual physical exams, nurse health 24/7 along with teledoc. so a variety of ways to get the service you need. this plan also offers benefits above and beyond medicare, such as

routine--hearing exam, we got silver sneakers as a added benefit, we got transportation to and from medical facilities and doctor appointments and we also got meal service for folks coming home from the hospital for example so they dont have to worry what they have to cook and how to take care of themselves from a meals perspective. as i was talking about on the other sides, this blue shield medicare ppo plan continues to give members flexibility and choice. with this blue shield plan, of course you got blue shield state wide network of doctors expansive network of doctors, but in addition we got the blue cross blue shield

association network nation wide to support our members as well. there may be innetwork providers that may not be able to take new members, but rest assured, continuing members will continue to get their care from a in network provider they have today. we maintained consistency with the benefits and member cost share so no surprises starting 1-1. out of network providers. so, out of network providers is very key as well. even though we got the california providers, the nation wide network as well. this is a key facet of this plan along with the current plan, which is the ability to see