• BCBS Prepares for a Consumer-Focused Future

    May 15, 2014

    While many insurers tiptoed into the health insurance marketplaces—or remained on the sidelines entirely—BCBS companies strapped on their shoulder pads and rushed onto the new playing field.


    “In almost every market across the country, Blue Cross Blue Shield offered coverage when the exchanges were launched. And we are looking at having full participation soon once Blue plans enter a few outstanding markets,” says Maureen Sullivan, senior vice president of strategic services and chief strategy officer for the Blue Cross and Blue Shield Association (BCBSA). “We have been around for more than 80 years, and our ability to serve the needs of individuals and small groups in our local communities is well established.”

    The BCBSA is a federation of 37 independent companies that collectively provide insurance to roughly one-third of the U.S population. The vast majority of that coverage is provided through employer-sponsored plans; the Blues serve 76 percent of Fortune 500 companies.

    The individual market, while a sliver of the total insurance market, has always been an important niche for BCBSA. Consumerism is changing the health insurance market, and the Blues can take nothing for granted.

    A Consumer-Centric Approach

    “Consumers are taking over the driver’s seat,” says Sullivan. “This is not just happening in the individual- and small-group market. We’re also seeing it in the large-group market with a move to private exchanges, in the Medicare market with the advent of Medicare Advantage, and in the expansion of Medicaid managed care.

    “So we are approaching the consumer market in a very different way than we have previously,” she says, pointing to the need for transparency that allows consumers to choose among insurance options. BCBSA is also trying out different approaches, which range from broad networks with less cost sharing and high premiums to narrow networks with high cost sharing and relatively lower premiums—and everything in between.

    “In many markets, we are offering a wide range of options that give individuals the ability to make a decision that meets their family’s needs,” she says.

    The Blues are also reaching out to consumers in ways that would have seemed strange just a few years ago. For example, through a partnership with a tax software/filing company, BCBS companies educated members about the new benefits and costs of healthcare reform, and offered tax preparation discounts.

    Care Delivery Changes

    The Blues are also partnering with health systems and physician organizations to experiment with new care delivery models, such as ACOs and patient-centered medical homes. The reshaping of care delivery is equally important to the reshaping of the insurance market, Sullivan says.

    “I refer to the care delivery transformation as the quiet revolution,” she says. “Whether innovations are coming from Blue Cross Blue Shield or they are provider-sponsored or they are from a competitor, we as an industry care deeply about hearing what models work and learning as an industry how we can begin to influence change.”

    The Journey Ahead

    “Like Blue Cross and Blue Shield, health systems are going to find that we’re going to learn directly from the consumer—more than we ever have before— about what they value, what is working, and what we need to do differently,” she says. “Ten years from now, health care will be much more consumer friendly, and there will be much more certainty about the quality and cost effectiveness of the care that is being delivered. But it is a journey to get there.”

    Maureen Sullivan is senior vice president of strategic services and chief strategy officer, Blue Cross and Blue Shield Association, Chicago.