Dr. Esteban Lopez of BCBS Texas on Meeting Needs of Complex Populations in a Complex Time


How Blue Cross Blue Shield of Texas is serving vulnerable populations through outreach and a variety of collaborative programs.

Esteban Lopez, MD

5 min read

Oliver Wyman and Altarum Institute, with support from the Robert Wood Johnson Foundation (RWJF), recently completed a major, multi-disciplinary study of the consumer health-information space. The research examined the barriers vulnerable consumers encounter in accessing and using health information, and also explored how the marketplace views and prioritizes the health information needs of those consumers. The study findings are available here.

Blue Cross Blue Shield of Texas (BCBSTX), a division of Health Care Service Corporation, is one organization that is committed to serving the health information needs of vulnerable consumers. In this post, first published in July 2016, Dr. Esteban Lopez, Texas Chief Medical Officer & Market President, Southwest Texas, discusses how BCBSTX is serving vulnerable populations through outreach and a variety of collaborative programs. (For more of Dr. Lopez’s thoughts on health, the uninsured and Latino health trends, follow him on Twitter @DrEstebanLopez.)

Oliver Wyman Health: Can you provide an overview of BCBSTX membership? And roughly what percent of your overall membership primarily speaks a language other than English? 

Dr. Lopez: BCBSTX serves over 5 million Texans through employer group plans, individual policies, and government programs (Medicare, Medicaid, and Dual Eligible products). Thirty-five percent of our Medicaid membership does speak Spanish.

In 2012, BCBSTX began serving several new Medicaid programs, including a program for pregnant women and children in eight counties. We started with 8,000 members and it has grown to 31,000. BCBSTX also is honored to launch a new program serving children with special healthcare needs in 31 counties.

OWH: What steps have you taken within your Medicaid business to tailor your offerings, communications, etc., to better meet the needs of the populations you serve? 

Dr. Lopez: BCBSTX understands the importance of respecting different cultural beliefs and communicating with members and their families in the language and manner that they prefer. For our Texas Latino communities, BCBSTX has used community-based patient navigators to help people enroll in a plan that best fits their needs. BCBSTX also provides telephonic translation services and on-site interpreters to help Medicaid members communicate with providers or connect with social services. We offer a member website in English and Spanish and member handbooks are available in Spanish for our Medicaid programs. In addition, because Austin has a large refugee population, we have provided translation services for over 30 different languages including Arabic and Vietnamese.

Beyond translation, BCBSTX believes in investing in the health and wellness of our community and connecting with local members. Thus far in 2016, the BCBSTX Medicaid team has attended 116 community events and touched over 13,000 individuals.

To prepare for our new population of children with disabilities who are dependent upon technology, we engaged a disability consulting company that conducted focus groups with families, teachers, and providers to inform the development of our programs and services. I personally participated in this focus group and found the information enlightening and inspiring.

OWH: How are you working with the health care delivery system to better serve these populations? 

Dr. Lopez: BCBSTX supports the Health Home model to better serve the physical, behavioral, and social needs of our members. Health Homes are either primary care provider practices or specialty care provider practices that include care coordination and family-centred care in conjunction with data management.

One example of Health Home efforts is the Lone Star Circle of Care (LSCC), an FQHC that has 29 Central Texas clinics. LSCC is staffed by 150 family practice, dentistry, psychiatry, pediatrics, and pharmacy providers. There are 3,500 BCBSTX Medicaid Members in their panel.

BCBSTX and LSCC have a Health Home agreement that focuses on improving outcomes, value-based care, and quality intervention activities, such as for asthma management, immunizations, and reducing potentially preventable events. Of note, LSCC receives a monthly per-member incentive from BCBSTX to fund an onsite outreach nurse. This Nurse Care Coordinator conducts member outreach and coordinates with community social services programs. BCBSTX provides data and key metrics on a monthly basis to help inform opportunities for care for our members.

OWH: What steps did you take to better understand these particular populations? 

Dr. Lopez: Our relationship with Lone Star Circle of Care started in 2014.  We have learned a great deal from this relationship and plan to start three more similar arrangements in the coming year. One arrangement will be specifically geared toward a clinic that works with disabled and medically fragile children. We are also exploring working with behavioural health clinics that integrate primary care into their operations.

OWH: Looking ahead, how else might you enhance your product and service offerings for these populations? 

Dr. Lopez: BCBSTX is excited about an innovative new program designed to serve some of the most vulnerable members of our communities – children and young adults with disabilities and special healthcare needs. Our BCBSTX Medicaid Plan is busy preparing to serve these new members – hiring nurses and licensed clinical social workers who will be responsible for spearheading our new Service Coordination programs. Our Service Coordinators will be field based, visiting members and their families in their homes to assess needs and connect members with the best providers to serve their physical, behavioural, and social needs. BCBSTX is also actively expanding our provider network to include providers of long-term services and supports, such as personal care services, respite care, supportive employment, and home nursing care.

Additionally, in January 2016 HCSC launched PAVE (Pharmacists Adding Value & Expertise), a program that utilized community pharmacists to improve medication adherence among Medicare members in Illinois, New Mexico, and Montana. Since the first-of-its kind program started, we have seen a significant uptick in medication adherence, which reduces the number of emergency room trips or urgent visits to the doctor. Although the program is not currently offered in Texas and Oklahoma, we are looking to expand it to throughout these states to support more lines of business.

  • Esteban Lopez, MD