The initiative builds onAltais, which Blue Shield formed in August to reduce physicians'administrative burdens. (Photo: Getty)

(Bloomberg) –Blue Shield of California, one of the state'slargest health insurers, is rolling out a series of experimentsaimed to improve health care for patients and physicians, thecompany said on Tuesday.

The program, called "Health Reimagined," ranges from expandedtelehealth connections in rural Butte County to building outprimary care in Monterey. New "community health advocates" in LosAngeles and elsewhere will help members with nonmedical needs, likehousing and food assistance.

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"We came to the conclusion that we couldn't just incrementallyimprove on a system that's fundamentally dysfunctional," said PaulMarkovich, chief executive officer of Blue Shield ofCalifornia.

Even before the coronavirus pandemic began, physicians sufferedfrom high rates of burnout and frustration with the medical system.Patients too are frequently flustered by the cost of care,difficulty getting it, and a system that doesn't fully meet theirneeds. Health insurers are a frequent source of ire for both.

"Patients are not satisfied. Providers are frustrated andburning out," Senior Vice President Peter Long said. The systemcosts an "inordinate" amount of money, he said, adding "when welook at that, we think that we need a solution or set of solutionsthat are commensurate with the magnitude of the problem."

Blue Shield of California, a tax-paying nonprofit with 4.4million members and $20 billion in revenue, aims to expand thoselocal programs that succeed quickly. The initiative builds onAltais, which the insurer formed in August to reduce physicians'administrative burdens. In April, Brown & Toland Physicians,one of the Bay Area's largest medical groups with 2,700 doctors and350,000 patients, joined Altais in a proposed acquisition.

"Altais was created with the express purpose of supportingphysicians adopting Health Reimagined," Markovich said.

Primary care doctors and independent practices have facedparticular stress. Many have seen revenue dry up as Covid-19 forcedthe cancellation of in-person appointments. The challengingeconomics of running a primary care practice have led many doctorsto join large hospital systems in recent years, a trend that someemployers fear will accelerate during the pandemic.

The Pacific Business Group on Health, a group representing largeCalifornia employers, has urged the federal government to expandsupport for primary care. "The impending collapse of independentprimary care practices represents a concern of vital nationalinterest that must be addressed swiftly to avoid profound andirreparable damage," the group wrote in a letter to Health andHuman Services Secretary Alex Azar this month.

In Monterey County, south of San Francisco, patients sometimeshave to wait six to eight weeks to get an appointment with aprimary care doctor, according to Michael Larsen, executivedirector of the Municipalities, Colleges, Schools Insurance Group,which manages health care for dozens of public agencies in thecounty.

Blue Shield is opening two Altais clinics in the county, andadding mental health and orthopedic services in response to needsidentified by Larsen's group. "We've been working on trying tobring in more primary care providers for a long, long time," Larsensaid. When the clinics are open, he said, the 14,000 people on hisplan will be able to get appointments the same day or next day.

Blue Shield isn't alone among insurers expanding into caredelivery. UnitedHealth Group Inc.'s Optum unit has almost 50,000doctors, according to the company's annual report. Humana Inc.announced a joint venture earlier this year with private equityfirm Welsh, Carson, Anderson & Stowe to expand primary care.And Kaiser Permanente, the California-based health maintenanceorganization, has 23,000 doctors.

In California, Blue Shield says it wants to ease the burden onclinicians it works with. It's adopting technologies like voicerecognition so doctors can dictate notes into digital recordsinstead of typing them in by hand. It's also accelerating paymentsto doctors and hospitals. Another pilot program will liftprior-authorization rules if patients and clinicians undertake a"shared decision-making" session in which they review the evidencefor a course of treatment and agree on the best way forward.

Reaching displaced patients

Richard Thorp, a primary care doctor with Paradise MedicalGroup, said Blue Shield's support has been instrumental in helpingthe group's 20 or so clinicians survive the wildfires thatdestroyed Paradise, Calif., in November 2018.

"We had a number of docs we had to meet payroll for and we hadno revenue stream because we were out of business basically," hesaid.

In addition to grants from the insurer, assistance setting uptelehealth systems eventually allowed Paradise Medical Group toreach patients who had been displaced by the fire, Thorp said. WhenCovid-19 arrived this year, the practice was ready to move onlineseamlessly.

Now a community health advocate, funded by Blue Shield, works inThorp's clinic, which has relocated to nearby Chico. The advocatehelps patients with needs around food, transportation, lonelinessor shelter. And new payment arrangements from Blue Shield allowThorp and his colleagues to spend more time with the patients whoneed it the most, rather than limiting visits to 15 minutes.

The goal, Thorp said, is to have a health system with "thepatient and the clinician at the center of it, and not the healthplan or anyone else."

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