From The AIS Bookshelf:
Chapter 4: Blue Cross and Blue Shield Plan Trends
and Data
Health Plan Facts, Trends and Data: 2016-2017 21st Edition
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21st Editio n
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Chapter 4: Blue Cross and Blue Shield Plan Trends and Data
Chapter 4
Blue Cross and Blue Shield Plan
Trends and Data
What Is a Blue Cross Blue Shield Plan?
This section is excerpted from The AIS Guide to Blue Cross and
Blue Shield Plans, a new online website and database offered
by AIS (not affiliated with the Blue Cross and Blue Shield
Association or its member companies). For more information
visit https://aishealthdata.com/blu.
History, Function and
Structure of the Blue Cross and
Blue Shield Association
Blue Cross and Blue Shield Association (BCBSA) is a
national federation of 36 independent, community-based
and locally operated companies, each of which is licensed
to use the Blue Cross and/or Blue Shield trademarks.
As members of the national BCBSA, plans are
licensed to operate in geographically defined areas and
generally do not compete with other Blues-branded
products. This allows BCBSA to coordinate branding,
marketing, lobbying and other efforts on a national basis
to the benefit of all licensees.
The 36 BCBS companies provide coverage in all 50
states, the District of Columbia, Puerto Rico and some
other points outside the U.S. BCBS affiliates typically
operate in just a single-state region, but there are several
exceptions. BCBS of Kansas City and CareFirst BCBS
both have multi-state service areas, while BCBS entities
in Pennsylvania and California split those states into
multiple regions.
History
The history of BCBSA mirrors the evolution of the
health insurance industry in the U.S., with major events
pointing to economic drivers and the introduction of social programs. According to BCBSA, the Blue Cross symbol was first designed and used in 1934 by the company
that would later be known as Blue Cross of Minnesota.
In 1939 the Blue Shield symbol was created to be used in
marketing the Buffalo Blue Shield Plan. The logos have
been redesigned several times.
The Blue Cross Commission was created in 1946.
Associated Medical Care Plans was created in 1947, and
renamed Association of Blue Shield Plans in 1960, changing its name to Blue Shield Association in 1976. In 1982
the Blue Cross Commission and the Blue Shield Association merged and became the Blue Cross and Blue Shield
Association.
In 1950, Blue Cross of Western Pennsylvania entered
into the U.S. Steel Agreement, a contract to provide
health coverage to members outside its service area via
local participating plans or affiliates. This agreement
became the model for how today’s BCBS plans cooperate
to serve large national accounts.
Because of the organizations’ long history and consistent branding efforts, many people — even industry
insiders — are under the impression that “Blue Cross/
Blue Shield” is a single entity. Further, the terms are
often used synonymously to represent traditional feefor-service indemnity coverage free of any controversy
surrounding HMOs.
The BCBS system enrollment reached a peak in 2003
when more than 88 million Americans (about a third)
were enrolled in BCBS branded plans. Today the proportion remains about the same, with BCBS system-wide
medical enrollment at about 106 million (including non-
75
Health Plan Facts, Trends and Data: 2016-2017
BCBS-branded products), according to AIS’s Directory of
Health Plans.
Blue Cross and Blue Shield plans’ dominance has
traditionally been in employer-sponsored plans, in both
risk-based and non-risk (ASO) markets. Until recently,
these commercial markets were viewed as the major
growth area for health insurers. Blues plans and others
in this market had hoped that the Affordable Care Act
mandate for individual coverage would strengthen this
market. So far, many BCBS plans (and others) are finding
that serving the newly covered individuals is not the
profit center that they are accustomed to. BCBS plans
took a prominent role on most state exchanges, assuming that their brand-recognition would help them win
market share and that the risk-corridor program would
come through to offset losses. Since this hasn’t worked
out as hoped for many Blues plans, they are now leading the charge to drastically raise premiums on exchange
plans for 2017.
Blues' Share of Commercial and Public-Sector Niche Medical Insurance
Markets, by Enrollment
Total Commercial Risk
44.37%
Individual (non-Group)
53.02%
Total Group Risk
42.63%
Large Group Risk
41.13%
Small Group Risk
51.74%
Medicare Supplement
40.46%
Public Sector Risk
9.59%
Medicare Advantage
16.70%
Medicare CCP
16.34%
Medicare Cost
PACE Program
Medicare PFFS
30.51%
0.00%
3.01%
Dual Eligibles
14.85%
Medicaid HMO
Medicaid FFS
SCHIP
16.86%
0.00%
13.49%
SOURCE: BLU, The AIS Guide to Blue Cross and Blue Shield Plans-Online, AIS’s new online database of Blue Cross and Blue Shield plans.
For more information, visit https://aishealthdata.com/blu, and for a free demo, visit https://aishealthdata.com/dashboard/blu/demo/blu.
Although exchanges have greatly increased the number of individuals covered, growth in the public sectors
(dark pie slices above) may offer more stable growth. Not
only did the ACA expand opportunities for Medicaid
and dual eligibles, but companies with more experience
in those sectors were less shaken by the impact of the
high-maintenance exchange enrollees.
AIS’s Directory of Health Plans’ data show that publicsector enrollment increased 8% during 2015. With some
strategic acquisitions, BCBS affiliates overall maintained
their 14% share of that market but did not make any major gains. In fact, about half of all BCBS affiliates do not
have any Medicaid operations whatsoever.
BCBS plans do have a good toehold in the public
sector via several contracts with the Federal Government
to perform claims processing services for Medicare Part
A and Part B claims, for beneficiaries covered under traditional (non-Managed) Medicare. Growth in Medicare
Advantage enrollment is a threat to this market, however,
76
as more retirees who have grown up with managed care
find Medicare HMOs to have budgetary advantages.
BCBS Association Services
Primary functions the Blue Cross and Blue Shield Association fulfills on behalf of its licensees are:
u Licensing. Coordinate BCBS licenses to assure that
members are not in competition with one another and
that the largest possible geographic area is covered by
BCBS licensed entities. To this end, BCBSA imposes its
authority over mergers and acquisitions among BCBS
entities, expansions of geographic markets, and transfers
licenses to other entities in instances when a license is
terminated. BCBSA ensures that all licensees are in compliance with their license requirements.
u National Programs. Develop and administer national
programs that mutually benefit BCBS licensees and their
clients and members by expanding the scope of services
Chapter 4: Blue Cross and Blue Shield Plan Trends and Data
available, by increasing the efficiency with which plans
conduct business and by promoting the influence of
BCBS brands or otherwise furthering BCBSA agenda.
National programs include FEP, BlueCard, the Blue
Healthcare Bank, retirement programs and other programs to coordinate and showcase BCBS initiatives in
fraud prevention, medical technology assessment and
health care delivery systems. Participation in national
programs is required by BCBS license agreements.
u Lobbying and Industry Representation. BCBSA takes
its history, numbers and brand recognition to Capitol Hill
to further the organization’s agenda in all areas of health
care legislation. The existence of the BCBSA structure
was viewed as essential in implementing the original
Medicare program enacted in 1965, as well as subsequent
enhancements to that program. BCBSA had a powerful seat at the table when national health reform efforts
were being negotiated. America’s Health Insurance Plans
(AHIP) is the other major health insurance lobby, representing more covered lives, but many BCBS plans belong
to both groups and their agendas are often aligned. Now
that health reform has been enacted into law, BCBSA
is providing leadership to its member plans on implementation of new requirements and how to make the
most of opportunities presented in the law. At the same
time, some AHIP members have become large enough to
create their own representation to Congress and regulators. Splintering in the non-Blue lobby could enhance
BCBSA’s power.
u Provider Networking advantages. Although BCBS
affiliates generally create their own provider networks
within their regions, the BCBS brand speaks volumes
for them in negotiations. The association boasts that 96%
of hospitals nationally are contracted with its affiliates.
Providers have to deal with the local BCBS plan in order
to serve a large proportion of privately insured patients.
Additionally, the BlueCard program brings access to
almost anyone in their market who is covered by an outof-state entity.
u Collective Bargaining for National Accounts. BCBSA
established a National Labor Office in 1965 to negotiate
union contracts that span across multiple BCBS service
areas. Today, collectively bargained contracts account for
approximately 17 million BCBS members or about onefifth of the system’s total enrollment.
Blue Cross and Blue Shield Association
Leadership
The Association is headquartered in Chicago, with
offices in Washington, D.C. Association leadership as of
June 2016 was as follows:
u Scott P. Serota, President and Chief Executive Officer
u William A. Breskin, Vice President, Government
Programs
u Bhaskar Bulusu, Vice President, Enterprise Information
u Maureen A. Cahill, Senior Vice President, Chief
Human Resources Officer
u John Cerisano, Vice President, Federal Relations
u Teresa N. Clark, Vice President, Clinical Affairs
u Kathy Didawick, Vice President, Congressional
Relations
u Alissa Fox, Vice President, Federal Relations
u Paul Gerrard, Vice President, Strategic
Communications
u Jena L. Estes, CPA, Vice President, Government
Program Integrity
u Justine Handelman, Vice President, Policy
u Kris Haltmeyer, Vice President, Health Policy and
Analysis
u Trent Haywood, M.D., J.D., Chief Medical Officer,
Office of Clinical Affairs and Chief Medical Officer
u Kari Hedges, Vice President, National Programs
u Mitchell J. Helfand, Vice President, Finance
u Kim Holland, Vice President, State Affairs
u Nasir Khan, Vice President and Chief Technology
Officer
u Robert Kolodgy, Senior Vice President, Financial
Services and Government Programs and Chief Financial
Officer
u Shirley S. Lady, Vice President, Transformation
Services/Operations
u Petar Naumovski, Vice President, Chief Information
Security Officer (CISO)
u Scott Nehs, Senior Vice President, General Counsel
and Corporate Secretary
u William B. O’Loughlin, Vice President and Chief
Information Officer, Federal Programs
u Doug Porter, Senior Vice President, Operations and
Chief Information Officer
u Cynthia Rolfe, Vice President, Consumer Brand
Strategy
u Maureen E. Sullivan, Senior Vice President, Strategic
Services and Chief Strategy Officer
u Mark Talluto, Vice President, Strategy, Marketing and
Sales Programs
u Jennifer Vachon, Senior Vice President, Administrative
Services, Chief of Staff and Assistant Corporate Secretary
u Jody Voss, Vice President, Strategic Business Services G
77
Health Plan Facts, Trends and Data: 2016-2017
Blue Cross and Blue Shield Plan Enrollment Data
Blue Cross Blue Shield Plan Enrollment, 2016
Insurer
Service Area
Enrollment
Blue Cross and Blue Shield of Illinois
Illinois
8,097,998
Blue Cross and Blue Shield of Texas
Texas
5,016,093
Blue Cross Blue Shield of Michigan
Michigan
4,361,597
Anthem Blue Cross of California
California
4,356,448
Horizon Blue Cross Blue Shield
New Jersey
3,805,901
Highmark Blue Cross Blue Shield
Pennsylvania
3,651,368
Blue Shield of California
California
3,508,145
BlueCross BlueShield of Tennessee
Tennessee and Nationwide
3,441,147
Blue Cross and Blue Shield of Florida, Inc.
Florida
3,012,664
Blue Cross and Blue Shield of Alabama
Alabama and Nationwide
2,898,178
Blue Cross Blue Shield of Massachusetts
Massachusetts
2,801,128
Blue Cross and Blue Shield of North Carolina
North Carolina
2,689,888
Blue Cross Blue Shield of Minnesota
Minnesota, plus Medicare Advantage in other states
2,565,250
Anthem Health Plans of Virginia
Virginia
2,324,640
CareFirst BlueCross BlueShield
District of Columbia, Maryland, Virginia
2,155,680
Premera Blue Cross
Alaska, Washington
2,010,289
Independence Blue Cross (IBC)
Delaware, Maryland, New Jersey, Pennsylvania
1,834,901
Blue Cross and Blue Shield of Louisiana
Louisiana
1,545,909
Anthem Blue Cross and Blue Shield of Ohio
Ohio
1,526,404
Anthem Blue Cross and Blue Shield of Indiana
Indiana
1,525,124
Excellus BlueCross BlueShield
New York
1,386,625
Anthem Blue Cross and Blue Shield of Colorado
Colorado
1,347,216
Blue Cross Blue Shield of Georgia
Georgia
1,339,081
Wellmark Blue Cross and Blue Shield of Iowa
Iowa
1,291,856
Triple-S Management Corporation
Florida, New York, Puerto Rico
1,272,262
Empire Blue Cross Blue Shield
New York
1,075,153
Blue Cross and Blue Shield of Oklahoma
Oklahoma
860,607
CareFirst BlueCross BlueShield
District of Columbia, Maryland, Virginia
849,886
Blue Cross Blue Shield of Arizona
Arizona and Nationwide
801,114
Anthem Blue Cross Blue Shield of Wisconsin
Wisconsin
783,951
Capital BlueCross
Pennsylvania
767,400
BlueCross BlueShield of South Carolina
South Carolina
761,156
Hawaii Medical Service Association
Hawaii, plus Medicare Advantage plan in Nevada
726,479
Blue Cross and Blue Shield of Nebraska
Nebraska
712,199
Blue Cross and Blue Shield of Kansas
Kansas
702,675
Regence BlueShield
Washington
701,369
Arkansas BlueCross BlueShield
Arkansas, Texas
653,315
Anthem Blue Cross and Blue Shield of Kentucky
Kentucky
621,047
Blue Cross & Blue Shield of Mississippi
Mississippi
603,664
BlueCross BlueShield of Western New York and BlueShield of
Northeastern New York
New York, plus Medicare Advantage plans in other states
553,477
Blue Cross of Idaho Health Service, Inc.
Idaho and other states for national groups
509,943
Blue Cross and Blue Shield of New Mexico
New Mexico
495,639
Regence BlueCross BlueShield of Oregon
Oregon
482,535
Highmark Blue Cross Blue Shield Delaware
Delaware
465,525
Anthem Blue Cross and Blue Shield of Connecticut
Connecticut
455,966
Blue Cross and Blue Shield of Kansas City
Kansas, Missouri
448,744
Care1st Health Plan
California, plus Medicare Advantage membership in Texas
448,152
78
Chapter 4: Blue Cross and Blue Shield Plan Trends and Data
Blue Cross Blue Shield Plan Enrollment, 2016 (continued)
Insurer
Service Area
Enrollment
Anthem Blue Cross Blue Shield of Missouri
Missouri
420,415
Blue Cross & Blue Shield of Rhode Island
Rhode Island
410,482
Blue Cross Blue Shield of North Dakota
North Dakota
355,088
Wellmark Blue Cross and Blue Shield of South Dakota
South Dakota
317,392
Anthem Blue Cross and Blue Shield of Nevada
Nevada
309,799
Blue Cross and Blue Shield of Montana
Montana
291,766
Highmark Blue Cross Blue Shield West Virginia
West Virginia
289,913
Regence BlueCross BlueShield of Utah
Utah
268,345
Blue Cross and Blue Shield of Kansas City
Kansas, Missouri
255,378
Anthem Blue Cross and Blue Shield of Maine
Maine
222,966
CareFirst BlueCross BlueShield
District of Columbia, Maryland, Virginia
219,073
Blue Cross and Blue Shield of Vermont
Vermont
218,139
Anthem Blue Cross and Blue Shield of New Hampshire
New Hampshire
195,948
Regence BlueShield of Idaho
Idaho
133,498
Premera Blue Cross
Alaska, Washington
89,711
Blue Cross and Blue Shield of Wyoming
Wyoming
72,899
SOURCE: BLU, The AIS Guide to Blue Cross and Blue Shield Plans-Online, AIS’s new online database of Blue Cross and Blue Shield plans. For more
information, visit https://aishealthdata.com/blu, and for a free demo, visit https://aishealthdata.com/dashboard/blu/demo/blu.
BLU is independently researched and published by AIS. It is not affiliated with or sponsored, endorsed or approved by the Blue Cross Blue Shield
Association or any of the independent Blue Cross and Blue Shield companies.
79
Health Plan Facts, Trends and Data: 2016-2017
BCBS Plan Medical Enrollment by State, 2016
State
Blues
Enrollment in
State
Market Share
as % of
Insured
as % of
Population
State
Blues
Enrollment in
State
Market Share
as % of
Insured
as % of
Population
2,132,177
61.70%
43.88%
Montana
307,208
46.87%
29.74%
Alaska
94,353
22.02%
12.78%
Nebraska
779,883
61.76%
41.13%
Arizona
749,162
17.48%
10.97%
Nevada
321,497
19.77%
11.12%
Arkansas
674,550
32.18%
22.65%
New Hampshire
212,618
27.86%
15.98%
California
8,463,885
26.78%
21.62%
New Jersey
4,167,829
56.85%
46.53%
Colorado
407,678
11.32%
7.47%
New Mexico
527,293
33.31%
25.29%
Connecticut
472,951
18.71%
13.17%
New York
3,042,159
18.10%
15.37%
Delaware
494,208
60.88%
52.25%
North Carolina
2,760,273
40.54%
27.49%
283,062
52.98%
37.40%
1,601,909
18.43%
13.79%
Alabama
District of
Columbia*
North Dakota
852,927
56.81%
126.88%
Florida
3,609,799
28.44%
17.81%
Oklahoma
881,964
37.17%
22.55%
Georgia
1,485,669
26.70%
14.54%
Oregon
489,308
13.92%
12.14%
Hawaii
726,929
54.38%
50.78%
Pennsylvania
5,783,145
48.59%
45.17%
Idaho
533,471
48.06%
32.24%
Puerto Rico
1,267,749
52.64%
36.49%
Illinois
8,176,876
66.54%
63.58%
Rhode Island
300,721
46.71%
28.47%
Indiana
1,606,113
43.35%
24.26%
South Carolina
824,200
32.43%
16.83%
Iowa
1,524,382
64.00%
48.80%
South Dakota
328,906
46.00%
38.31%
Kansas
1,100,655
55.72%
37.80%
Tennessee
3,240,621
60.56%
49.10%
Kentucky
703,226
24.98%
15.89%
Texas
5,970,559
38.38%
21.74%
Louisiana
1,754,821
45.24%
37.57%
Utah
291,163
14.39%
9.72%
237,866
23.72%
17.89%
Vermont
250,732
45.96%
40.05%
Maryland
2,445,492
49.65%
40.71%
Virginia
2,601,942
51.49%
31.04%
Massachusetts
2,855,835
37.82%
42.03%
Washington
2,927,006
46.15%
40.82%
Michigan
4,359,109
51.40%
43.93%
West Virginia
444,881
38.72%
24.12%
Minnesota
2,617,103
41.79%
47.67%
Wisconsin
424,848
11.98%
7.36%
Mississippi
674,261
35.76%
22.53%
Wyoming
83,509
32.42%
14.25%
Missouri
943,197
28.66%
15.50%
Foreign
5,541
0.13%
-
Maine
Ohio
*Enrollment in D.C. and some other areas may be counted by employer group headquarters, however a large number of employees live outside of
the state.
SOURCE: BLU, The AIS Guide to Blue Cross and Blue Shield Plans-Online, AIS’s new online database of Blue Cross and Blue Shield plans. For more
information, visit https://aishealthdata.com/blu, and for a free demo, visit https://aishealthdata.com/dashboard/blu/demo/blu.
BLU is independently researched and published by AIS. It is not affiliated with or sponsored, endorsed or approved by the Blue Cross Blue Shield
Association or any of the independent Blue Cross and Blue Shield companies.
METHODOLOGY: Enrollment compiled from surveys and supplemented by publicly available data sources, researched by AIS editorial staff. Enrollment
data is as of the first quarter 2016 and includes medical enrollment only. Does not include pharmacy, Medicare Part D, dental or any specialty
enrollment.
NOTE: Includes membership in plans that are not marketed under BCBS brand, where applicable.
80
Health Plan Facts, Trends and Data: 2016-2017 21st Edition
an Fa ct s,
He alt h Pl
d Da ta :
Tr en ds an
20 16 -20 17
21st Edit ion
From The AIS Bookshelf:
Chapter 4: Blue Cross and Blue
Shield Plan Trends and Data
This PDF includes a 6-page excerpt on “Blue Cross and Blue Shield Plan Trends and
Data ” from the AIS book Health Plan Facts, Trends and Data: 2016-2017.
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