Blue Shield and Cal Docs Team Up

Blue Shield and CMA are teaming up for a new health care model.

We know there’s a lot to process what with the coverage of the families being separated at the border and all. But here’s something in the insurance world we need to pay attention to:  Blue Shield of California and the California Medical Association (CMA) just announced a multi-year collaboration to develop and support a new health care model. Blue Shield will invest $30 million to support the initiative, beginning with pilot projects in Monterey and Butte counties. According to a statement, the aim is to “bring health care into the digital age, tie pay to value and create a patient-centered experience through home- and community-based services.” At the foundation of the projection is a new technology infrastructure designed to largely unburden physicians from overwhelming administrative work. The goal is for Blue Shield and CMA to scale the projects statewide with a focus on supporting independent physicians. For the nonprofit Blue Shield, this is the latest step in the plan’s ongoing efforts to rework health care. Earlier this year, Blue Shield announced it is expanding its suite of home-based care programs. The health plan is collaborating  with Landmark Health to bring care to the homes of people suffering from many chronic conditions, and Blue Shield’s nationally-recognized in-home palliative care is now available in all 58 California counties.  Also this year, Blue Shield and Gemini Health announced a new drug-price transparency service for prescribers and patients that provides real-time, patient specific cost information on their prescriptions and alternative drugs during the doctor visit.


Assoc Health Plans Cross State Lines
The Trump administration finalized plans this week to allow small companies and the self-employed band together and buy health insurance outside of Obamacare rules. The plans are cheaper but, naturally, offer fewer protections. The Congressional Budget Office estimates that 4 million people, including 400,000 who otherwise would go without insurance, are expected to join association health care plans by 2023. This is what California Insurance Commissioner Dave Jones had to say: “Today, the Trump Administration issued its final rule regarding Association Health Plans, described in the rule as a type of Multiple Employer Welfare Arrangement (MEWA), promoting these plans as a path for groups of businesses or organizations to obtain health insurance coverage. Some MEWAS have had a troubling history in California, including cases of MEWA fiscal insolvency, inability to pay consumer claims, and allegations of fraud, so California law prohibits the formation of any new MEWAS. The final rule recognizes continued state regulation of MEWAS; however, outside California, the Trump Administration’s final rule threatens the continued existence of comprehensive health insurance coverage, as those who are sick may no longer be provided coverage that meets their health care needs or may obtain coverage through an arrangement that may later fail when needed most.”

Palo Alto Medical Foundation and UnitedHealthcare Announce Great Collab Results
Palo Alto Medical Foundation (PAMF), part of Sutter Health, and UnitedHealthcare recently announced some great results from their accountable care organization (ACO) relationship.The positive results are based on data from more than 75,000 patients enrolled in UnitedHealthcare employer-sponsored health plans who have been receiving care from PAMF physicians since 2015. The ACO has reduced the number of emergency room visits for UnitedHealthcare plan participants by 7 percent since 2015 and increased use of less expensive, generic prescription drugs by more than 4 percent. In addition, the program has reduced the number of short-term hospital admissions by about 9 percent. UnitedHealthcare and PAMF have slashed annual medical costs by more than $15 million over the last two years. The relationship was established in 2015 in Alameda, Contra Costa, San Mateo, Santa Clara and Santa Cruz counties. Earlier this year, Sutter Health and UnitedHealthcare expanded their accountable care relationship to 17 additional counties: Amador, Butte, El Dorado, Marin, Napa, Nevada, Placer, Sacramento, San Benito, San Joaquin, San Francisco, Solano, Sonoma, Stanislaus, Sutter, Yolo and Yuba. About 30,000 people enrolled in UnitedHealthcare’s employer-sponsored PPO and Group Medicare Advantage PPO for retirees health plans are eligible to benefit from the expansion. More info here or download the Value-based Care Report.

Buen Trabajo Covered California
For the second year in a row, the Radio Mercury Awards honored Covered California for its creative marketing, this time for an ad titled “Soccer.”  The Spanish-language radio spot was developed to air prior to the 2018 FIFA World Cup to inform listeners that they are eligible to sign up for health care coverage during Covered California’s special-enrollment period if they have lost, or will be losing, their health insurance.

In a format that resembles the narration of a soccer game, the spot features a commentator repeating the phrase “¡Perdiste tu seguro!” (“You lost your insurance!”). The spot ends by saying, “Es difícil pensar en otra cosa cuando pierdes tu seguro médico. Por eso Covered California te da la oportunidad de solicitar un nuevo plan de salud si perdiste tu cobertura.” (“It’s hard to think of anything else when you lose your health insurance. That’s why Covered California gives you the opportunity to apply for a new health plan if you lost your coverage.”)

Traditionally, the World Cup has a large audience with Latinos. The campaign started in March and is ongoing, airing on Pandora, Spotify, iHeartRadio, Univision, Entravision and other digital platforms, as well as prominent Spanish-language radio stations in Los Angeles and the Riverside-San Bernardino area. Covered California estimates the ad has been listened to 3.4 million times.


CAHU Revitalizes Foundation
CAHU announced it is revitalizing the dormant CAHU Foundation, a 501(c)3 nonprofit. The Foundation aims to focus on professional education, consumer engagement and health care financial education. CAHU says the industry is in desperate need of someone to take the lead in establishing a more accurate understanding of the value health insurance agents add to communities. The CAHU Foundation will begin proactively educating the general public with sound information regarding health insurance and the costs of health care. CAHU Foundation announced a kick-off masquerade gala and silent auction September 14 -15 in Del Mar. To register for the gala click here. To learn more about the CAHU Foundation click here.



Ever Wonder How So Many Got Addicted to OxyContin?
Don’t miss How American Got Hooked on a Deadly Drug on Kaiser Health News. It starts like this: “Purdue Pharma left almost nothing to chance in its whirlwind marketing of its new painkiller OxyContin.”


Can’t Get No (Benefits) Satisfaction? Hodges-Mace Tracy Funk to the Rescue

Hodges-Mace will offer a free webinar to discuss how employers can leverage different decision support tools to reinforce their overall benefits strategy and enhance their employees’ enrollment experience. Tracy Funk, a Cal Broker contributor and Hodges-Mace VP of carrier solutions, will cover:

– Why decision support is so important
– What different decision support tools are available (there are more than you think!)
– How to evaluate your workforce and their desired enrollment experience
– When to implement a successful decision support strategy

The free webinar happens June 26, 10-11am PT. Register here.

 Lowering Drug Spends and More
Global Health Resources is offering a free, interactive webinar. Presenters include folks from Valued Pharmacy Services and former United Health exec Tom Cogan, Regional Senior Vice President, Meltzer Group. The presentation will cover the following info:

  • What the Future Holds – 47% of prescription drug spending by 2020 will be specialty drugs. Learn about the implications.
  • Crazy Cost Savings – Learn about how companies are reducing their pharmacy spend by 20-25%.
  • The AI Revolution – Hear about the revolutionary impact of artificial intelligence on pharmacy benefits.

Controlling Pharmacy Spend with Intelligent Technologies for Improved Outcomes happens Thursday, June 28, 10-11am PT. Register here.


Unum Tool Helps Parents and HR Manage Parental Leave
Unum has introduced a leave management solution to new and existing customers to help better manage their leave programs. The LeaveLogic platform allows employees to create a leave plan which consolidates all leave benefits and lists the tasks needed to ensure proper leave planning and a successful return to work. It also educates the HR manager by delivering training on supporting the employee through their leave event. For its own employees, Unum also introduced new paid parental leave benefits for both mothers and fathers in the U.S. this year. The benefit provides six weeks of paid leave to care for a newborn, or a child placed through adoption or foster care, at any time during the 12 months following birth, adoption or fostering. More info here. 


AMA Adopts Medical Tourism Guidelines
As a growing number of U.S. citizens are having medical procedures abroad. In response, the American Medical Association adopted new ethical guidance on medical tourism at its annual meeting last week. The guidelines are designed to help doctors understand their responsibilities with patients who have received medical care outside the U.S. or who are looking to do so. The last set of guidelines came out in 2008. Some of the highlights of the guidelines are that doctors should:

  • familiarize themselves with issues in medical tourism to help support informed consent;
  • help patients understand the nature of risks and likelihood of benefits, especially when patients desire an unapproved therapy;
  • advise patients who consult them in advance whether the physician is willing to provide follow up care;
  • offer their best professional guidance, as they would for any care decision; and
  • respond compassionately to requests for follow-up care from returning patients who had not consulted the physician before seeking care abroad, and carefully consider the implications before declining to provide nonemergent follow-up care.

The AMA principles address insurance coverage for care abroad and the use of internationally accredited institutions. The principles also urge coordinated follow-up care, a transfer of medical records that adhere to HIPAA requirements, and the tracking of safety and quality data for procedures performed outside the U.S.


IICF Western Regional Forum
June 21, The Millennium Biltmore, Downtown Los Angeles
The one-day regional format provides opportunities for greater participation and networking with colleagues here in the West and beyond. There will be ample time for networking with speakers as well. Topic this year Drivingis Diversity: Cultivating Individual and Industry Confidence. Learn more at

2018 DMEC Annual Conference
August 6-9, Hilton Austin, Austin, TX
More than 700 disability and absence management, HR and legal professionals will discuss paid leave, mental health, disability and more at the 2018 DMEC Annual Conference. Workshops and panel discussions include:

  • The Business Impact of Paid Leave:  An Interactive Workshop
  • Mental Health in the Workplace:  The Invisible Disability, Now Visible
  • FMLA/ADA Lessons Learned: Recent Court Cases, Jury Verdicts and Settlements
  • It Seems Simple, But: The Complexities of Reasonable Accommodation
  • ADA Leave Cases Post-Severson
  • Minimizing the Impact of Musculoskeletal Disorders in the Workplace
  • State by State:  Paid Family and Medical Leave Legislation
  • Disability and Fitness for Duty in Transgender Employees
  • Get Explicit About Implicit Bias

See a full program and more info here.

CAHU Health Care Summit
August 7-9, San Diego Hilton, Bayfront
This year’s theme is “New Hope for the Modern Agent.” This year CAHU will be offering multiple Continuing Education tracks on Medicare, IFP and Group Benefits, Business Development and more. There will be two NAHU certification courses offered on August 7. Individuals who register for the Summit and a certification course will receive a $50 discount upon completing both registrations. Details here.

Golden Gate Association of Health Underwriters
4th Annual NORCAL Medicare Summit
August 16-17, DoubleTree Hotel, Pleasanton, More info at

CAHU Foundation Gala
September 14, Fairmont Grand Del Mar, San Diego
Please join CAHU for a Masquerade Gala to revitalize the CAHU Foundation. Festivities begin at 5:30pm at the famous Fairmont Grand Del Mar. Formal attire is requested.  Gala tickets and hotel reservations can be purchased here. Or call (800) 322-5934.  More info at the CAHU Foundation website.

November 1-3, Gaylord Palms Resort and Convention Center, Orlando, Florida
Detailed information about NAILBA 37 will be available soon. Exhibit hall and sponsorship opportunities available here.  Or contact for more info.


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