Three Years of Virtual Blue and the Future of Virtual First Care at Blue Shield of California

Summary

---

Episode Overview

Podcast: Becker’s Healthcare Podcast
Episode Title: Three Years of Virtual Blue and the Future of Virtual First Care at Blue Shield of California
Date: May 3, 2026
Host: Elizabeth Casalow
Guest: Tim Lieb, Senior Vice President of Commercial Markets, Blue Shield of California

This episode explores the three-year milestone of "Virtual Blue," Blue Shield of California’s Virtual First care initiative. Host Elizabeth Casalow and guest Tim Lieb discuss the design principles, clinical outcomes, cost impacts—especially for high-risk populations—expansion to underserved areas, and the future vision for virtual care programs. The conversation is rich with practical examples, nuanced data on utilization, and lessons learned at the intersection of technology, member preference, and provider collaboration.

---

Key Discussion Points & Insights

1. Background of the Guest and Virtual Blue (00:17 - 01:46)

• Tim Lieb’s Role:

  • Senior Vice President, Commercial Markets, overseeing all employer groups, both small and large, and holding P&L responsibilities.
  • Lieb started in healthcare as a customer service rep and has comprehensive industry experience.
  • “I’ve really seen the gamut and have a comprehensive understanding around what is it that members need, what is it that customers are trying to solve for.” (B, 00:41)

• What is Virtual Blue?

  • Not purely virtual: Virtual Blue is a "Virtual First" program integrating virtual components for primary and specialty care, with traditional in-person (brick and mortar) support.
  • Developed post-Covid by prioritizing member preferences for flexible, continuous care.

---

2. Clinical Impact and Cost Savings (01:46 - 03:53)

• Cost Reductions:

  • General members: 7-10% lower overall cost of care.
  • High-risk members: 30%+ reduction (approx. $17,280 saved per member per year).

• Driving Factors Behind Savings:

  • Enhanced longitudinal care, constant member-provider connection, comprehensive patient records, and early identification of issues.
  • Members with chronic conditions, who often get lost in the system or overuse ER, are better guided to right-size care.
  • “It’s that comprehensive patient record… It’s the early identifier, right. It’s three years into the program. This is what we’re seeing on the results.” (B, 02:53)

---

3. Utilization Trends and Behavioral Health (03:53 - 04:41)

• Increased Primary Care Use:
  • More members proactively utilize primary care.
  • 85% of primary care users receive behavioral health assessments.
  • Reduced wait times for primary and specialty care, addressing one of the industry’s biggest pain points: access.
  • “We’re seeing greater primary care utilization... Shorter time to get to primary or specialty care.” (B, 04:05)

---

4. ER Avoidance and Real-World Scenarios (04:41 - 05:53)

• ER Visit Reduction:

  • Emergency room visits dropped by 10%+.

• Practical Example:

  • For traveling members or those with time constraints (like teachers or parents), urgent care needs are met virtually, preventing unnecessary ER trips and minimizing missed work.
  • “It really makes sure that it meets the needs of when someone can actually make that virtual visit which an in-person visit might have been so difficult for them...” (B, 05:25)

---

5. Evolving Employer and Provider Perspectives (05:53 - 07:51)

• Employers:

  • Initially required significant education ("Is this virtual only?").
  • Now, employers are interested in customizing and expanding the virtual-first approach to other benefit programs.

• Providers:

  • Mixed feelings, especially in capitated models, but generally see Virtual Blue as a way to fill existing care gaps, particularly in PPO frameworks.
  • “It really forms as how providers then see it as… 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.” (B, 07:31)

---

6. Lessons Applied to Individual Market Products (07:51 - 09:22)

• TriO HMO Plan Integration:
  • Virtual primary care is being added to individual market plans.
  • Key lessons: the program must be simple, intuitive, with clear copay structures and messaging to remove barriers.
  • Higher engagement leads to easier follow-up and continuity, especially for lab work and chronic care.
  • “If it’s simple, intuitive, it works, right? ... The better our messaging can be about what the program is and how it works, it helps a ton.” (B, 08:04)

---

7. Impact in Rural and Crisis Settings; Equity (09:22 - 11:04)

• Serving Rural Areas & Crisis Response:
  • Virtual care allows members—especially in rural or wildfire-affected regions—to access providers without long travel or when roads are impassable.
  • “You can have the access… right from your home. It’s not about driving 30 minutes... especially in an emergency... during the wildfires, maybe you couldn’t get to your provider, but then how would we still get a prescription?” (B, 09:55-10:24)

---

8. Future of Virtual Blue and Industry Guidance (11:04 - 13:19)

• Looking Ahead (Next 3 Years):

  • Expect broader integration of Virtual Blue into various programs.
  • Anticipate a shift in how providers think about and deliver virtual vs. in-person care, with the member experience as the guiding principle.
  • Envision more virtual services, integrated pharmacy delivery, and deeper digital engagement.

• Advice to Industry Leaders:

  • Embrace virtual-first approaches as they reflect many members’ preferences, particularly for chronic condition management.
  • “About 90% of all healthcare costs are being driven by chronic care or chronic conditions... we have to be thinking about different ways to engage them...” (B, 12:30)

---

Notable Quotes & Memorable Moments

• “I started in this business from the very beginning just as a customer service rep. So I’ve seen everything... It’s been a joyous ride.” — Tim Lieb (00:37)
• “Virtual Blue is not saying everything has to be virtual... It was what were member preferences.” — Tim Lieb (01:46)
• “For high risk members… more than a 30% reduction... that equates to $17,280 per member per year on average.” — Elizabeth Casalow (02:27)
• “Early on, [sales conversations] were all about education... Is this virtual only?... Now, customers… are designing what they want.” — Tim Lieb (06:08-06:45)
• “You can have the access… right from your home. During the wildfires, maybe you couldn’t get to your provider, but then how would we still get a prescription?” — Tim Lieb (10:00)
• “Embrace it and understand it’s not for every member, but it is the way so many members want to engage.” — Tim Lieb (12:26)

---

Timestamped Segment Highlights

• 00:26 - 01:30: Tim Lieb’s background and expertise.
• 01:46 - 02:25: Definition and intent behind Virtual Blue.
• 02:25 - 03:53: Cost and clinical outcomes, especially for high-risk groups.
• 04:05 - 04:41: Utilization statistics, primary and behavioral health access.
• 04:53 - 05:53: Real scenarios where virtual care substituted for ER usage.
• 06:04 - 07:51: Shifts in employer and provider dialogue since launch.
• 08:04 - 09:22: Lessons from employer plans being brought to the individual market.
• 09:45 - 11:04: Importance for rural, underserved, and crisis-affected areas.
• 11:11 - 12:17: Tim Lieb’s vision for the next evolution of Virtual Blue.
• 12:26 - 13:13: Strategic advice to other healthcare leaders.

---

Conclusion

This episode provides a detailed look at how Virtual Blue has evolved over three years to achieve measurable cost savings, improve engagement—especially for those managing chronic conditions—and bridge gaps in underserved and crisis-affected communities. Tim Lieb champions a member-centric philosophy and anticipates even greater integration of virtual services within Blue Shield of California’s offerings, urging other industry leaders to do the same while balancing member pluralism and provider collaboration.

Transcript

[A]

Hi everyone, this is Elizabeth Casalow with the Becker's Payer Issues podcast. I'm really excited today to be joined by Tim Lieb, Senior Vice President of Commercial Markets at Blue Shield of California. Tim, thank you so much for joining us today.

[B]

Thank you for having me, Elizabeth. Looking forward to the conversation.

[A]

Yeah, me too. So before we jump into things, I would love to hear a little bit more about your role at Blue Shield of California and your background leading up to this role.

[B]

Perfect. So as you said, Senior Vice President, Commercial Markets and what that means for us is I have accountability for all of our employer groups, everything from our small group, those under 100 all the way through, including our government, private sector, municipalities, full profit and loss responsibilities for those and thus directly linked to what our products are and what our needs are in the marketplace. You know, I know you said also what was way of background. I started in this business from the very beginning just as a customer service rep. So I've seen everything and what I view is from that background of starting there to doing consulting, to working with other carriers, I've really seen the gamut and have a comprehensive understanding around what is it that members need, what is it that customers are trying to solve for. So you know, it's a long, long history, but it's been a joyous ride.

[A]

So today we're going to talk about the three year anniversary of Virtual Blue, Blue Shield of California's flagship Virtual first care program. So maybe before we get into some of the numbers, could you just tell our listeners what Virtual Blue is like and what you're striving to do with it?

[B]

Yeah. So Virtual Blue is not saying everything has to be virtual, but what it was doing was saying what would be this Virtual first type program that members were looking for. So how did we have a virtual component with primary care, with specialist care, but then it was the standard brick and mortar healthcare backing that program up. So really we were delving into post Covid what was worked from a member's perspective and what did we want to carry forward. And so that's what the program was built around is we what were member preferences.

[A]

So recent data shows a 7 to 10% lower overall cost of care with Virtual Blue. But one really striking figure is more than a 30% reduction for high risk members. So that equates to $17,280 per member per year on average. So what's actually happening clinically with that population that's driving such an outsized result?

[B]

So two main things. It's one, it's how that care is being handled and that it's a constant connection then with the member. So it's very longitudinal type view of how we're supporting the member. So within that you have your primary care, you have your specialist, they're looking at the labs, they're really connecting. And it's that comprehensive patient record of how to treat the member. Now everything is, it's the early identifier. Right. It's three years into the program. This is what we're seeing on the results. They could grow, they could erode some. But what was pivotal for us is we see lower types of care that are really your big cost drivers. So when you think about some of the higher costs, those with chronic conditions, they may go to the emergency room more, they're going to see different levels of care. They're really kind of getting lost in the system. And this is a program that really helps them navigate and always gets them to the right care and has the resources available.

[A]

So what does utilization look like with a virtual first plan? You know, thinking we're going to talk a little bit more about the ER side of things. But even beyond that, what are you seeing trends wise, Overall?

[B]

I mean, overall we're seeing greater primary care utilization. And then even within that, that primary care, 85% of those members are getting a behavioral health assessment. So we're seeing shorter, you know, time to get to primary care, we're seeing shorter time to get to the specialty care. So it's really being responsive. In a world right now where access is probably one of our biggest problems, you know, we're seeing members really struggling to get access to their primary care or to the specialist that they need to see.

[A]

So to transition into some of those ER numbers, emergency room visits dropped by more than 10%. So can you walk me through all a real member scenario where Virtual Blue intercepted what could have been an ER visit?

[B]

Yeah, I mean, a great one is for the person who's traveling, right. For the person who's traveling that suddenly they're at a meeting. Could be just someone going down to Southern California, they're at a meeting and suddenly they're getting sick. They're able to call the primary care. They have all the information, they have the full clinical record they can prescribe, they can handle. But also it's for, you know, what about the school teacher? Those that are more on a program where they need a different level of access. So how do they get the care or how do they get that visit for their child or for themselves? And so it really makes sure that it meets the needs of when someone can actually make that virtual visit which an in person might visit might have been so difficult for them to actually get to or would have taken. They would have had to take time off to get that visit.

[A]

So what have sales conversations looked like with employers from when you first launched this product to today? And also what have, what is the dialogue with providers look like when it comes to this offering?

[B]

So first, what is that sales dialogue? Right. Early on it was all about education. It was all about like how would this program. It was really answering probably more the questions of wait, so is this virtual only? It was really trying to say how does it all work and how is it again something that we saw as a members wanted that type of program. So that was one in the beginning where it became, was it almost became less and less about. Let me just educate you on this virtual blue product too. Well could I have that in these other programs? So like customers already were going to, they were designing, right? They were saying what do I want and how would I love to see the program morph and, and really adapt to what they saw as their needs. So it's usually as a slice type program. You know, this isn't for every member. We know that. So it's always like talking to the customer about how, how this is a fit for what they're looking for relative to how the providers. I think it's mixed, right? I'll just be transparent. I think, you know, when we're putting it in and you know we're looking at it in our models that have capitation, there's always a question to say wait, how are they going to see a member versus what will I see? But in a PPO model it really is a compliment, right? It doesn't really take away from what's there. It really forms as how providers then see it as. 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.

[A]

So I'd love to hear you're now adding virtual primary care to the trio HMO plan for individuals. So what were some learnings from the employer group experience that you're now translating to the individual market?

[B]

I mean if it's simple, intuitive, you know, it works, right? So that zero copay was something that we recognized. While it doesn't have to be zero, it has to be a simple copay structure, it has to really remove the barriers and that's what we saw, the better our messaging can be about what the program is and how it works. It helps a ton. And the last item that really was a learning is when we can engage them in that level of virtual care, it's easier to do the follow up. It's easier to keep them connected and to make sure we're going to be able to catch if it's a chronic condition or if it's getting them to the lab. It's because again, we still may be sending them to the lab, but it's easier. Right. They didn't have to do that initial visit to then get to the lab. It wasn't a. I had to run around. It's very straightforward. And so what we have learned is through Virtual Blue we really got a good sense of what we could do with it and then to start building within our other programs to see how it can actually further reduce cost and really create greater access for members.

[A]

One other thing that came up when I was reading the release about the three year anniversary was expansion to rural areas and health professional shortage areas as well as supporting members during wildfires. So what's a story from on the ground that illustrates why virtual first matters in those contexts in a way that maybe traditional telehealth that's acting more supplementally might struggle with?

[B]

Yeah, I mean it's so funny because this is the one where I really get excited, Elizabeth, because you know, I grew up in a really small town and I remember we had to drive 30 minutes to get to the provider. Right. To get to any of the doctors. So Virtual Blue eliminates that. It's you can have the access, you have the ability to have that provider visit right from your home. It's not about driving through 30 minutes to even get to a provider, but then in a case of an emergency, right where the roads might be challenged or there are other issues you could have that visit. So during the wildfires maybe you couldn't get to your provider, but then how would we still get a prescription or what would be needed? So it's the level of comprehensive care that you can get in a virtual setting that it is really empowered our general thinking about what do we need to again deliver for our members. It's really challenged how we think about care. And just as importantly, I think it's really delivered what again members were needing and the ability to create and have that primary care relationship. But not having to travel is a welcome item for our members.

[A]

What do you think is next for Virtual Blue over the next three years?

[B]

I Just see it as it's going to be such a component of so many of our programs and it's making us rethink virtual care in general. I think it might shift how a number of the providers actually deliver virtual care themselves around what they enable virtual, what they do, brick and mortar. But for me, it's making sure we are really thinking about the member. And so it's less about what is a product for, it might be easy to administer. It's more of a but what is the member need? And to me, it's really bridging that gap of connecting more and more to how they want to engage, to what other services they may need. So it'll be the expansion of Virtual Blue, but then it's going to be what else? What other services do we make available virtual? How do we then think about between pharmacy delivery and everything else to the member because of how they want to interact with the healthcare system?

[A]

Do you have any final thoughts for industry leaders who may be weighing Virtual first products or. Or just kind of toying with that space?

[B]

I mean, I would simply say embrace it and understand it's not for every member, but it is the way so many members want to engage. And so how do we really begin to think about helping to support them? Because overall, like in our current society, about 90% of all healthcare costs are being driven by chronic care or chronic conditions. And if you think about that level of chronic conditions that are out there, we have to be thinking about different ways to engage them to make sure they're getting the care to help drive down costs and create better outcomes for our society. And it means thinking differently about how care is being rendered and just as importantly, how they want to engage.

[A]

Well, Tim, thank you so much for joining us today.

[B]

Thank you so much, Elizabeth, for having me.

[A]

Of course. And to our listeners, if you'd like to listen to more podcasts from Becker's Healthcare, you can visit beckershospitalreview. Com.