Nation’s second-largest public employee health benefits purchaser CalPERS picks new health plan for the first time in 20 years to administer Preferred Provider Organization (PPO) plan

OAKLAND, Calif., June 12, 2024 /PRNewswire-HISPANIC PR WIRE/ — Blue Shield of California has been named by the California Public Employees’ Retirement System (CalPERS) as the sole health plan to provide its Preferred Provider Organization (PPO) offering.

The state agency provides benefits for California’s public employees, retirees and their families, representing 1.5 million people, and making it the second largest public purchaser of employee health benefits in the country, behind the federal government.

Blue Shield will serve approximately 400,000 CalPERS PPO plan members across the state, beginning in 2025, adding to 176,000 CalPERS members Blue Shield already serves with its Trio HMO, Access+ and Medicare Advantage plans, for a total of 576,000 members.

“We are thrilled to be selected and have this opportunity to expand our partnership with CalPERS,” said Paul Markovich, president and CEO, Blue Shield of California. “We believe our work together can serve as a model for affordable health care for the rest of the country and we’re eager to get started on delivering access to cost-effective, high-quality care and service to CalPERS and its beneficiaries.”

This is the first time in two decades CalPERS has selected a new administrator for the PPO plan, following a lengthy and thorough competitive bidding process. The nonprofit health plan’s winning bid was based on the ability to offer CalPERS and its PPO members access to both broad and narrow network offerings that ensure high-quality, equitable and affordable care.

In the solicitation process, CalPERS emphasized the importance of population health management, including navigation, care and support to help empower members in their health journeys. Included Health, Inc. was selected to provide virtual care, navigation and population health management services for CalPERS’ 250,000 active employees and their families who select the PPO plan, while Blue Shield will provide all other administrative services including provider network access and claims processing. Blue Shield will provide the full suite of services for the 150,000 CalPERS retirees and their families in the PPO plan.

“We are excited to work with Blue Shield of California, which has demonstrated a true commitment to not only make sure CalPERS members are well served, but to help change health care quality and cost for all Californians,” said Don Moulds, chief health director of CalPERS.

Blue Shield has demonstrated its commitment to expanding access to high-quality care and bringing down costs through innovative initiatives, partnerships and products. Recently, the health plan collaborated with Purchaser Business Group on Health to launch the Care Excellence Program in California. This program is aimed at connecting employers and public entities, including CalPERS, with top-performing primary and specialty providers.

The nonprofit health plan is also focused on addressing health equity, one of California’s major goals for the state’s healthcare system, and providing access to care beyond physical health. Blue Shield’s award-winning Wellvolution program is just one of many innovative solutions to expand access to integrated behavioral health.

“As the only statewide nonprofit health plan in California, we share CalPERS’ commitment to improving the lives of the people we serve,” said Tim Lieb, senior vice president of Growth at Blue Shield. “We are excited to continue partnering with CalPERS and Included Health as we lead the way to a healthcare system that is worthy of our family and friends and sustainably affordable.”

Blue Shield of California is working closely with CalPERS and Included Health to ensure a seamless transition for members.

About Blue Shield of California
Blue Shield of California strives to create a healthcare system worthy of its family and friends that is sustainably affordable. The health plan is a tax paying, nonprofit, independent member of the Blue Shield Association with more than 4.8 million members, over 7,100 employees and more than $25 billion in annual revenue. Founded in 1939 in San Francisco and now headquartered in Oakland, Blue Shield of California and its affiliates provide health, dental, vision, Medicaid and Medicare healthcare service plans in California. The company has contributed more than $77 million to the Blue Shield of California Foundation in the last three years to have an impact on California communities.

For more news about Blue Shield of California, please visit news.blueshieldca.com. 

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SOURCE Blue Shield of California