Blue Shield of California debuted its virtual-first Virtual Blue healthcare plan just over three years ago. Now, the data is rolling in.
The program began in 2023 through a collaboration with tech-enabled healthcare platforms Accolade — now owned by Transcarent — and TeleMed2U. The program has no out-of-pocket costs for visits with virtual-only providers, can often deliver same-day care and now has more than 150,000 members. Blue Shield is even tacking virtual primary care options onto its Trio HMO plan, expanding offerings into the individual market.
Tim Lieb, Blue Shield of California’s senior vice president of commercial markets, recently joined the “Becker’s Payer Issues Podcast” to discuss Virtual Blue’s early strengths and challenges.
He said Virtual Blue is not advocating for a fully virtual healthcare ecosystem. Instead, the priority was addressing member needs, offering virtual components for primary and specialty care but with “the standard brick-and-mortar healthcare backing that program up.” Blue Shield leaders said this model could help travelers, shift workers, busy families, those with mobility issues and those in areas with provider shortages.
“I grew up in a really small town, and I remember we had to drive 30 minutes to get to the provider,” he said. “Virtual Blue eliminates that.”
Compared to equivalent members without Virtual Blue, program members had 7% to 10% lower overall care costs, averaging $468 less per person each year. Emergency department visits were down by more than 10%, as well. Among a small sample of high-risk members during Virtual Blue’s first year, Blue Shield observed $17,280 in savings per member per year, surpassing a 30% cost cut. More than half of Virtual Blue members have at least one chronic condition and use virtual care to meet these more intensive needs.
Mr. Lieb attributed savings to “longitudinal” views of members, interconnected providers and care navigation. Three-fifths of surveyed members said they would have either delayed care or gone to more expensive care sites, like the ED or urgent care, if they did not have Virtual Blue.
“We see lower types of care that are really your big cost drivers,” he said.
According to the news release, average wait times are substantially lower than statewide in-person times, down to one day for primary and mental health care and three days for specialty care.
When it comes to the sales dialogue with employers, Mr. Lieb said conversations started from a place of education — like clarifying the virtual-first model — but transitioned to questions around integrating Virtual Blue with other programs.
“It’s usually as a slice-type program. This isn’t for every member. We know that,” he said.
When it comes to providers’ opinions, though, Mr. Lieb said, “It’s mixed. … I’ll just be transparent.” Provider concerns generally boil down to capitation and member distribution. However, Mr. Lieb said Virtual Blue could serve as “a complement” for PPO providers.
“It doesn’t really take away from what’s there,” he said. “It’s really a conduit of how they’re going to also see members. And, really, it’s filling gaps that they can’t meet at this point in time.”
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