Blue Cross Blue Shield Plan News Roundup: July 2023

Blue Shield of California and Microsoft are collaborating to enhance members’ ability to engage in their health care by building an ecosystem in the cloud that securely integrates relevant, authorized information from disparate sources of data. Blue Shield is leveraging Microsoft’s scalable technology and processing power to derive insights faster to improve members’ access to affordable care in partnership with providers. Blue Shield of California is a tax paying, nonprofit, independent member of the Blue Shield Association with 4.8 million members, over 7,500 employees and $24 billion in annual revenue.

A new three-year agreement has been finalized by Blue Cross and Blue Shield of Oklahoma (BCBSOK) and OSU Medical Center. This agreement was effective July 1, 2023, and keeps the hospital in network through June 30, 2026, for BCBSOK members. As the state’s oldest and largest private health insurer, Blue Cross and Blue Shield of Oklahoma provides health care benefit plans for more than 800,000 Oklahomans. Blue Cross and Blue Shield of Oklahoma is a division of Health Care Service Corporation.

DocGo, a provider of mobile health services, announced new payer agreements with EmblemHealth and Blue Cross Blue Shield of Tennessee, representing an additional 6.7 million covered lives. Other existing payer partners include UnitedHealthcare, Aetna in New York and New Jersey, Elevance Health, Cigna and L.A. Care and in total represent more than 20 million covered lives. And 19 open deals in the sales pipeline could provide medical care to an additional 250,000 patients if closed, the company said.

Elevance Health, Inc. reported second quarter 2022 results reflecting strong financial performance, including double-digit growth in revenue, operating earnings, and adjusted earnings per share. Medical enrollment totaled approximately 47.1 million members as of June 30, 2022, an increase of 2.7 million, or 6.1 percent from the prior year quarter. Operating revenue was $38.5 billion in the second quarter of 2022, an increase of $5.2 billion, or 15.6 percent, from the prior year quarter.

Health Care Service Corporation (HCSC) is responsibly integrating both artificial and augmented intelligence to positively transform the prior authorization experience. The company operates health plans in Illinois, Montana, New Mexico, Oklahoma and Texas, providing benefits for 18 million members. HCSC, which received over 1.5 million prior authorization requests in 2022 alone, has now expanded use of a proprietary augmented intelligence tool that streamlines and accelerates the prior authorization (PA) process up to 1,400 times faster.

Highmark Blue Shield has expanded its network by adding two health systems in Southeastern Pennsylvania in preparation for its upcoming move into the region. The newly formed contracts are with Grand View Health in Sellersville, Pennsylvania, and Doylestown Health in Doylestown, Pennsylvania. These two health systems join Temple Health and Penn Medicine, both based in Philadelphia, which had previously signed contracts with Highmark earlier in the year. The addition of these healthcare providers further strengthens Highmark’s network and enhances its ability to serve the community.

Independence Blue Cross (Independence) and Sun Life U.S. announced a new collaboration to exclusively provide Stop Loss insurance for Independence’s self-funded group customers. Stop Loss insurance can protect self-funded employers who take on the financial risk of providing health insurance for their employees against large, unpredictable, or catastrophic losses from higher-than-anticipated claims.

Takeaway: AMI’s annual Blue Cross Blue Shield Plans Report provides comprehensive business intelligence on BCBSA and the health plans