Blue Cross Blue Shield News Roundup: May 2023

Year-end Blue Cross Blue Shield plans’ financial results included:

• HCSC – served 17.7 million members, managed $102.3 billion in managed medical spend, had premium revenues of $ 45.9 billion in 2021, a net underwriting gain of $49.3 billion in 2022, compared to net underwriting gain of $485 million in 2021, and net income of $1.5 billion in 2022, compared to $1.2 billion in 2021.
• Blue Shield of California – served 4.8 million members, had $23.9 billion in revenue, compared to $23.3 billion in 2021, a net operating loss of $1.4 billion, compared to a net operating gain of $328 million in 2021, a net income loss of $910 million, compared to net income of $237 million in 2021.
• Independence Blue Cross – through its affiliates and subsidiaries, Independence operates in 27 states and the District of Columbia serving 8.3 million members nationally, including 3.5 million in Southeastern Pennsylvania. Independence reported total revenue of $27.4 billion, up $2.65 billion or 10.7 percent over 2021. The company had net income of $156 million, due in part to an investment loss of $72 million.
• Blue Cross and Blue Shield of Minnesota – served 2.5 million members, and reported operating income of $187 million on $14.1 billion in total revenue, for an operating margin of one percent. A pre-tax net loss of $291 million was largely driven by unrealized investment losses.
• Blue Cross and Blue Shield of North Carolina – served membership of 4.4 million, revenue of $10.9 million, net income of $36.2 million. The recently passed Reorganization and Economic Development Act would allow BCBSNC to create a parent holding company where it would move much of its $4.6 billion surplus created from policyholders’ money to be invested without the regulatory oversight Blue Cross NC has now.
• Blue Cross Blue Shield of Michigan reported a net loss of $777 million as a result of several factors, including decline in investment portfolio values due to falling equity markets and rising interest rates, the ongoing cost of COVID-19, a one-time charge related to disposition of under-performing service entities and pricing pressures experienced in the Medicare Advantage market which led to lower revenue in that segment.

Blue Cross and Blue Shield of Vermont and Blue Cross Blue Shield of Michigan announced an agreement to formally affiliate and work together across both companies. Blue Cross and Blue Shield says the affiliation will provide the Vermont organization with additional expertise, as well as operational and information technology resources. Under the affiliation, Blue Cross and Blue Shield of Vermont would become part of the Blue Cross Blue Shield of Michigan enterprise family of companies, but will continue under the same name with the executive leadership team and workforce headquartered in Berlin, VT as they are today.

Blue Cross Blue Shield of Massachusetts (BCBSMA) signed a contract with Tufts Medicine that rewards the provider organization for reaching certain goals in a value-based payment structure that includes equity benchmarks. BCBSMA will pay Tufts Medicine for reducing inequities in care for colorectal cancer screenings, diabetes care, hypertension and child and adolescent well-care visits. Tufts Medicine joins Steward Healthcare Network, Beth Israel Lahey Health, Mass General Brigham and Boston Accountable Care Organization, which is part of Boston Medical Center. Those organizations signed their contracts with BCBSMA last December. Fifty-three percent of BCBSMA members in the state now have access to physicians who belong to the equity project. The contracts for all the plans began Jan. 1, 2023, with Tuft Medicine’s contract retroactive to that date.

Lori Herzog has been appointed president of Highmark Inc.’s third-party administrator segment. Previously holding leadership roles at prominent healthcare organizations, including Ascension’s ACM Holdings, Aetna’s Meritain Health, and UnitedHealth Group’s Optum, Herzog brings valuable experience to her new position. Highmark Health, the parent company, oversees Allegheny Health Network and Highmark Inc., operating Blue Cross Blue Shield affiliates in Delaware, West Virginia, and parts of Pennsylvania and New York. Herzog’s appointment reflects Highmark’s commitment to providing high-quality healthcare administration services and driving innovation in the industry.

Highmark Blue Shield, a subsidiary of Highmark Inc., has inked a health care provider deal in the Philadelphia area by contracting with Temple Health. Under the agreement announced Wednesday, Temple Health will serve Highmark as an in network provider for members who are covered by the Affordable Care Act, self-insured and other Highmark Blue Shield products effective Jan. 1, subject to regulatory approvals.

Casey Dungan, who has served as vice president and chief financial officer of BlueCare Tennessee since 2019, became the organization’s new president & CEO on May 1. He succeeds current leader Amber Cambron, who is retiring after 35 years of service with BlueCross BlueShield of Tennessee and a 30-year career with the BlueCare division. As president & CEO, Dungan will lead the executive team at BlueCare, assuming responsibility for the organization serving more than 700,000 of Tennessee’s most vulnerable residents.

Takeaway: Comprehensive business intelligence available on Blue Cross Blue Shield plans in AMI’s 2023-2024 Report