Q&A with Blue Shield of CA

By Thora Madden

Mental health benefits are top of the mind right now. Cal Broker reached out to Blue Shield of California’s Don Antonucci, senior vice president, commercial markets, and  Bryce Williams, vice president, lifestyle medicine, to learn more about what Blue Shield is doing with these important benefits.

Cal Broker: Can you describe the behavioral health plans you offer?

Blue Shield: We  recognize  the need to address the biological, psychological, and social factors that impact behavioral health. Through our whole-health approach and collaborative care philosophy, we improve quality and deliver an enhanced patient and provider experience to more effectively meet both the physical and behavioral needs of the individual.

Today, we are now living in unprecedented times, not experienced in the last 100 years. COVD-19, is causing worldwide disruptions in our work lives, family ties and economic activity. For the last three weeks, we have been sheltering-in-place, resulting in challenges to our daily routines. In addition, social distancing can easily lead to feelings of separation and loss of community, stress and anxiety.

Blue Shield is addressing these concerns by using technology to expand access to behavioral health services so members can receive the care they need, when they need it. By providing members with mental health services via phone, app or video conferencing, either with their current therapist or a new provider, we are ensuring 100% continuity of care while allowing practitioners and members to remain in their homes to reduce exposure and transmission of coronavirus.

Blue Shield, in its commitment to transforming health care, offers a comprehensive program of industry-leading behavioral health services. Our health plans provide a sophisticated approach to managing both inpatient and outpatient behavioral health services, employing specially trained behavioral health clinicians to assess a member’s situation and direct him or her to the most appropriate care setting. Having co-located care managers at Blue Shield ensures a seamless coordination process for the care of members with significant behavioral health needs. This collaborative approach promotes integrated care coordination which simplifies the member experience and enables personalized, relevant, and responsive care.

Another way Blue Shield is getting to the heart of behavioral health is through our partnership with Bright Heart Health, which provides expert care and support to adults through two-way video conferencing via phone, tablet or computer. Bright Heart Health works with over 150 hospitals and specializes in opioid disorders, substance abuse treatment, eating disorders, and chronic pain/opioid dependency. It is equipped to complete intakes within 24 hours of receiving a referral from a provider or a patient self-referral. This provides members with on-demand care, moving toward zero wait times to speak to a doctor.

Blue Shield’s value-added services provide our clients with game-changing opportunities which offer a broader clinical value story through seamless integration and improved competitive positioning through innovation and improved costs. Our newest cutting-edge solutions focus on technology, medical/behavioral integration, early intervention, and breaking down stigma while promoting awareness.

For example, Blue Shield’s award-winning lifestyle medicine program, Wellvolution®, combines best-in-class digital therapeutics, evidence-based therapies, and member-centric design to ensure members have access to personalized, flexible tools that work within their existing routines and address their unique problems. Blue Shield is committed to its members and focused at ensuring easy access to the holistic care that our members need.

To help members with social distancing during the current COVID-19 outbreak, Blue Shield is providing expanded access to premium programming for Sanvello, a Wellvolution program and #1-rated app for managing stress, anxiety, and depression through July 31, 2020. This includes access to 45 different mindfulness and meditation sessions, coping tools, guided journeys, and community boards – all at no additional cost to Blue Shield members during the COVID-19 crisis. We also adapted our Wellvolution diet and lifestyle programs to support members during this uncertain time. These 100% virtual programs are customized to meet current challenges, supporting members to take better care of their physical and emotional health while they remain at home.

Value-added services to improve behavioral health outcomes and enhance an employee’s experience:

Finding time to take care of your health can be a challenge for everyone. In addition to Wellvolution, Blue Shield offers a suite of value-added services – including 24-hour telehealth visits, 24/7 access to support services for personal and family issues, support services for employers, and autism support services – to help employees and employers stay focused and productive.

To make it easier for employers to offer, these value-added services are included in fully insured premiums, and available to self-insured clients through discounted bundles.

When members address their health and wellness needs using Wellvolution’s lifestyle medicine approach, they opt for a far less costly route for themselves and their employer. For example, over 75% if members enrolled in Wellvolution’s risk-reduction programs, which include stress management and behavior-change components, achieve an average reduction in weight of 5% within the first month and normalization of their hemoglobin A1C. Based on the results experienced by real users of our digital health network partners, members enrolled in Wellvolution can also expect to:

Prolong their lives up to 14 years by adopting core healthy behaviors

Reduce their risks for diabetes by 93%, heart attack by 81%, stroke by 50%, and all cancers by 36%

Lose 5% of their body weight or more

Develop better stress management and coping skills

Telehealth services

BlueShield offers 24/7/365 telemedicine and telebehavioral health services to members through Teladoc®, which includes a national networks of physicians and experienced psychiatrists, psychologists, therapists, and social workers to address a broad range of common illnesses and provide relief for issues like addiction, depression, stress or anxiety, domestic abuse, grief counseling, and more.

During the current COVID-19 outbreak, we are leveraging this technology to expand access to behavioral health services so members can receive the care they need when they need it. By providing members with mental health services via phone, app or video conferencing, either with their current therapist or a new provider, we are ensuring 100% continuity of care while allowing practitioners and members to remain in their homes to reduce exposure and transmission of coronavirus.

Telebehavioral health sessions conducted during the COVID-19 period are covered in the same way in-person visits are covered. All credentialed and contracted behavioral healthcare providers are now permitted to conduct telehealth video sessions for all routine services and certain advanced behavioral analysis, intensive outpatient treatment programs, and partial hospitalization program services. If a member is unable to participate in a face-to-face telehealth video session, outpatient providers may also conduct sessions via telephone. So, if members need care, they can call their provider to see how to receive services via their phone, Facetime or Skype.

We also are expanding telebehavioral health services coverage to all members, regardless of whether they previously utilized telehealth or if their plan explicitly includes telehealth provisions. And we are eliminating member cost sharing for Teladoc telehealth services through May 31, 2020.

LifeReferrals 24/7SM

Life can be overwhelming at times, and LifeReferrals 24/7 offers around the clock support for a wide range of services to cover personal, family, and work issues. was designed to promote early intervention and wellness to enhance productivity and assist employees in addressing their everyday concerns. This program provides support for members in all areas of their lives, from relationships, child and elder care, to financial and legal issues. The program includes three face-to-face counseling sessions with licensed therapists in each six-month period at no extra charge.

Workplace Support Services

Managers and supervisors receive telephonic support to assist with employee issues, such as substance abuse or personal and family problems, that could be impacting job performance. Workplace Support consultants are master’s level, trained clinicians who assist with the development of corrective action plans and a proper return to work, as appropriate, for the employee. Workplace Support consultants partner with managers and supervisors to ensure services are done in accordance with a client’s human resources and legal policies.

Autism Connections program

The Autism Connections program was designed to manage autism spectrum disorder effectively, with resources to market-leading clinical expertise with the right components to improve health and lower costs. This program has been offered to Blue Shield membership since July of 2012 and is provided from the Autism Center of Excellence in the San Diego Care Management Center.

CB: Are you seeing an uptick in interest in behavioral health benefits?

BS: Yes, Blue Shield has seen an increase of interest in behavioral health benefits across employer markets. Current statistical studies from various mental health experts reveal not only the increase of the recognition of mental illness amongst the U.S. population, but the issue of limited access to mental healthcare coverage and providers.

More employers are interested in improving access to mental health and well-being. About 75% of employers offered programs for depression and mental health in 2018, up from 34% in 2014.

The National Alliance on Mental Illness (NAMI) reports that one-in-five adults and one-in-six U.S. youth aged 6-17 experience a mental illness each year, underscoring a critical need for mental healthcare access across all patient populations. This is a pervasive issue that warrants the kind of attention other chronic diseases often receive.

Millions of Americans are going without access to care, per Mental Health America. Common barriers to mental health care access include limited availability and affordability of mental health care services, insufficient mental health care policies, lack of education about mental illness, and stigma.

That limited care access is not for lack of patient motivation. A 2018 survey from the National Council on Behavioral Health (NCBH) showed that 56% of patients want to access a mental healthcare provider, but many face care barriers.

The NCBH survey revealed that 42% of patients see high cost and limited insurance coverage as their main barriers to accessing mental healthcare. As patients face limited options for in-network mental healthcare, they either face large medical bills or are unable to visit a medical professional at all.

Limited health insurance access or in-network care are keeping many patients from visiting a mental healthcare professional. And even when a patient can find an affordable provider who will accept insurance, clinician shortages, fragmented care, and societal stigma are getting in the way of adequate care access.

CB: Have there been any significant changes in recent years?

BS: Tremendous change in healthcare legislation has created a dynamic environment of new opportunities to transform the fragmented delivery systems across the healthcare continuum. Blue Shield provides a solid foundation that ensures system transformation through innovative solutions which leverage the strength of our combined medical and behavioral expertise with industry-leading technology to drive integration and person-centered care. We are committed to providing seamless behavioral care, focused on quantifiable results.

Blue Shield is taking bold steps to transform a dysfunctional healthcare system. Our North Star is to create a healthcare system that is worthy of our family and friends and sustainably affordable.

Blue Shield recognizes that there is a mental health crisis among California’s youth. Studies show up to one in five students in the U.S. has a serious mental health need, yet in California too few of those affected receive the help they need. To help address the increasing critical mental health needs of California’s students, Blue Shield launched BlueSky, our signature mental health initiative focused on developing emotional resilience and emotional well-being in today’s youth. The goal of the initiative is to enhance awareness, advocacy and access to mental health resources for California’s middle and high school students. BlueSky will provide additional mental health clinicians in schools, train teachers on the signs of mental health issues, and empower students with in-person and online mental health support resources.

Blue Shield of California BlueSky supports student mental health in collaboration with leading organizations, including the California Department of Education, Wellness Together, NAMI and Do Something.org.

In response to COVID-19, which is affecting over 52 million students in the US, Blue Shield worked swiftly with our resources from these organizations to provide the following services:

  • DoSomething’s New State of Mind Campaign – tips on how to manage stress associated with COVID-19
  • Child Mind Institute – Supporting families through phone consultations, live video chats,
  • NAMI – Providing tips on how to stay and remain connected to your social network

Blue Shield is building a healthier California during the COVID-19 pandemic by developing resilience and emotional well-being in students.

CB: What can brokers and benefits people do to help employers/employees and individuals better understand their behavioral health benefits?

BS: We suggest partnering with your Blue Shield sales representative, who can provide you with the current layout of Blue Shield’s offerings. This will help ensure employers/employees and individuals have full comprehensive knowledge of Blue Shield’s mental health benefits.

Behavioral Health is bigger than a provider network, covered benefits, and tech-enabled care. Our members need to:

  • Recognize early signs and symptoms
  • Understand what programs are available and appropriate for them
  • Access care across all acuity levels, quickly

If we realize our vision in the healthcare delivery system, future members will actually need less health care because problems that lie in social and behavioral circumstance –and currently become medical issues – will be lessened.

This is key to emphasizing not only Blue Shield’s behavioral health and wellness benefits, but to communicate the importance of addressing mental health and helping a member find a clinician they can trust.

Bryce Williams, Vice President, Lifestyle Medicine,

Blue Shield of California

Don Antonucci, Senior Vice President, Commercial Markets,

Blue Shield of California