Top 3 large-group carriers in each state – Part 1

May 28, 2018 9:55 AM

There’s approximately $95 billion in fully insured health insurance premium in the U.S. large-groups (100+ employees) market — and there are just a few major carriers who control most of it.

“Bifurcated between the Blue Cross franchises and the big four — Aetna, Kaiser, UnitedHealthcare and Cigna — the Blue Cross franchises control 46% of that $95 billion, and the big four controls 39% of that marketplace,” says miEdge founder and CEO Mark Smith.

Using data from annual Form 5500 Schedule A reporting to the federal government by large-group employers, data analytics firm miEdge ranked the top three carriers in each state based on in-force group health premium, predominantly from the fully insured employer-sponsored healthcare market.

“What it shows is the marketplace is very much controlled by a select few,” says Smith.

Presented in alphabetical order, the listing highlights what the top carriers in each state and the District of Columbia are doing with their significant marketshare. Many are addressing the nation’s opioid crisis, others are investing in their local communities to build access to qualified doctors, nurses and specialty services. Some have recently won awards as top employers and healthcare providers themselves or are undergoing leadership changes with new executives.

Business handshake in the office

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Overview

There’s approximately $95 billion in fully insured health insurance premium in the U.S. large-groups (100+ employees) market — and there are just a few major carriers who control most of it.

“Bifurcated between the Blue Cross franchises and the big four — Aetna, Kaiser, UnitedHealthcare and Cigna — the Blue Cross franchises control 46% of that $95 billion, and the big four controls 39% of that marketplace,” says miEdge founder and CEO Mark Smith.

Using data from annual Form 5500 Schedule A reporting to the federal government by large-group employers, data analytics firm miEdge ranked the top three carriers in each state based on in-force group health premium, predominantly from the fully insured employer-sponsored healthcare market.

“What it shows is the marketplace is very much controlled by a select few,” says Smith.

Presented in alphabetical order, the listing highlights what the top carriers in each state and the District of Columbia are doing with their significant marketshare. Many are addressing the nation’s opioid crisis, others are investing in their local communities to build access to qualified doctors, nurses and specialty services. Some have recently won awards as top employers and healthcare providers themselves or are undergoing leadership changes with new executives.

Alaska

1) Premera Blue Cross: $62,144,270

2) Aetna: $22,172,071

3) Cigna: $10,884,134

In April, Premera received a Brand Excellence Award from the Blue Cross Blue Shield Association in the category of member retention for having high renewal numbers. The carrier currently has 163,000 members in the state, according to Premera. Jim Grazko, president of Premera Blue Cross Blue Shield of Alaska, said the award “reinforces our commitment toward making the customers’ experience simple and easy."

Alabama

1) Blue Cross and Blue Shield of Alabama: $547,274,235

2) UnitedHealthcare: $21,202,282

3) Aetna: $17,152,206

Blue Cross and Blue Shield of Alabama recently announced a partnership with the School of Medicine at the University of Alabama at Birmingham to create a program designed to increase the number of doctors in rural Alabama. According to the university, there is a primary care shortage in 62 out of 67 counties in the state. “Every Alabamian should have access to high-quality primary care. Partnering with UAB will provide primary care services to more Alabamians in rural areas,” said Tim Vines, president and CEO, Blue Cross and Blue Shield of Alabama.

Arkansas

1) Kaiser: $353,564,750 *

2) Arkansas Blue Cross and Blue Shield: $162,228,597

3) Health Advantage: $64,427,351

This spring, more than 150 employees of Arkansas Blue Cross and Blue Shield initiated the Fearless Food Fight, a campaign to fight hunger in the state. The company set a goal to pack 700,000 meals by December. “[W]e want to make a concerted effort to work with other organizations in the state that are committed to helping people have access to nutritious food,” said Curtis Barnett, president and chief executive officer of Arkansas Blue Cross.

* Walmart is headquartered in Arkansas and insured by Kaiser. Although Kaiser does not have a direct presence in the state, Walmart's premiums put the carrier in first place.

Arizona

1) UnitedHealthcare: $320,488,370

2) BlueCross BlueShield of Arizona: $237,278,943

3) Cigna: $137,252,702

Recently, United Health Foundation awarded a $1 million grant in Arizona to help provide healthcare services in the state. UnitedHealthcare Community & State CEO Heather Cianfrocco said the partnership with community organization Circle the City “will help people receive the vital health and social services they need and deserve.”

California

1) Kaiser: $8,678,722,127

2) Anthem: $4,382,890,344

3) Blue Shield of California: $2,674,683,853

In May, Kaiser Permanente received the Pharmacy Quality Alliance’s Excellence in Quality Award, recognizing high achievement in medication safety and appropriate use. It’s the eighth year in a row that Kaiser has received the award. “Medication safety and effectiveness are central to our mission to provide the best possible care to our members,” said Amy Gutierrez, vice president and chief pharmacy officer for Kaiser Permanente.

Colorado

1) Kaiser: $345,435,622

2) UnitedHealthcare: $245,445,964

3) Cigna: $219,876,189

In order to improve access to specialty care throughout the state, Kaiser Permanente Colorado in March announced $1 million in grants to four Colorado nonprofit organizations. “More and more community clinics are faced with the struggle between limited resources and meeting the unique health needs of their patients,” said Dr. Jandel Allen-Davis, Kaiser Permanente Colorado vice president of government, external relations and research. “We’re proud to work alongside these four local organizations as we develop sustainable ways to increase access to specialty care.”

Connecticut

1) Aetna: $403,534,002

2) UnitedHealthcare: $269,116,076

3) Anthem: $226,738,617

Of 16 companies headquartered in Connecticut that made the list, Aetna ranks highest, in 49^th place, among the 2018 Fortune 500 ranking of the top companies in the United States. Although a top national carrier, Connecticut is the only state where Aetna ranks No. 1 in large-group in-force premium. At a recent conference, Dr. Hal Paz, Aetna’s executive vice president and chief medical officer, emphasized the company’s commitment to fighting the opioid epidemic. “I’ve personally written almost 2,000 letters to providers telling them that they fall, based on our data, in the top 1% of prescribers,” he said. “We give them not only their data, but also provide CDC guidelines on the appropriate use of opioids in their practices.”

District of Columbia

1) CareFirst BlueCross BlueShield: $212,860,769

2) UnitedHealthcare: $149,876,201

3) Cigna: $141,865,030

In February, Washington, D.C.'s top insurance regulator ruled against CareFirst BlueCross BlueShield, saying the carrier must move forward with an order to pay back a portion of its surplus in rebates to its members in the District. The District’s Department of Insurance, Securities and Banking in 2014 ordered CareFirst's D.C. subsidiary, Group Hospitalization and Medical Services Inc., to reinvest $56 million for community benefit. CareFirst continues to challenge the decision. The most recent ruling, the company said in a statement, "clears the way for us to pursue legal remedies in the District of Columbia’s Court of Appeals."

Delaware

1) Highmark Blue Cross Blue Shield: $147,970,942

2) Aetna: $27,034,466

3) Cigna: $13,186,511

In order to combat the opioid crisis, Highmark in March set limits on the number of opioids that can be prescribed to first-time recipients. Patients receiving them for the first time due to an acute accident or procedure will only be able to receive a seven-day supply. "Data from the CDC show that people who use opioids for just one day have a 6% chance of becoming addicted. For those who use opioids for more than a week, the chances increase to more than 13%," said Sarah Marche, vice president of pharmacy services for Highmark Inc.

Florida

1) UnitedHealthcare: $2,216,739,067

2) Aetna: $1,885,626,258

3) Florida Blue: $1,355,219,307

When Florida was hit by damaging hurricanes last season, UnitedHealthcare employee volunteers and partner organizations provided emergency health services, contributed to community food and household good drives, staffed emergency care clinics and provided transportation where needed, the company said. “The mobile unit came and set up right in the heart of our downtown area to really help out with people who couldn’t get anywhere else,” said Rodney Cannon, mayor of Frostproof, Fla.

Georgia

1) Kaiser: $3,331,214,863

2) Anthem: $718,404,651

3) UnitedHealthcare: $370,761,050

Kaiser’s monopoly in the Peach State “particularly jumped out at me,” said miEdge’s Mark Smith. He noted the wide gap between Kaiser’s more than $3 million in premium and Anthem’s just over $700,000. The carrier co-hosted the Total Health Forum at the Georgia World Congress Center in March, where top athletes such as Stephen Curry addressed the importance total mental and physical health. “We can only be as healthy as our communities,” said Chairman and CEO Bernard J. Tyson.

Hawaii

1) Hawaii Medical Service Association: $448,002,331

2) Kaiser: $247,324,627

3) UHA: $76,587,980

At the company’s annual meeting in May, new president and CEO Michael B. Stollar shared his vision for the carrier’s future. “Leading HMSA is an honor and privilege that comes with profound responsibilities,” said Stollar. “My job is to ensure that we continue working with every stakeholder to build a community system of health that’s safe, affordable and accessible, and delivers the kinds of health and well-being outcomes that Hawaii’s people deserve.”

Iowa

1) Wellmark Blue Cross Blue Shield: $819,840,402

2) UnitedHealthcare: $84,798,025

3) Aetna: $26,339,995

This month, Wellmark ranked third among the top 500 midsized employers (1,000-5,000 employees) nationally in Forbes magazine’s annual ranking of the best employers in America. Through the Wellmark Foundation’s BlueCare Giving program, employees volunteered nearly 38,000 hours to nonprofit organizations while the Wellmark Foundation donated more than $1.8 million to nonprofit organizations across the state, the company announced in March.

Idaho

1) Regence BlueShield: $108,832,729

2) PacificSource Health Plans: $11,894,580

3) Kaiser: $11,798,204

In order to empower patients suffering from cancer and to help them maximize benefits, in April Leslie Foren, Regence Personalized Care Support’s provider and consumer outreach lead, made a presentation on working with health insurance carriers at a cancer symposium, Answer2Cancer. “We’re honored to have been invited back to reach out to the local cancer patient and caregiver community, which depends on palliative care benefits like the ones Regence provides,” Foren said. “This is a huge opportunity to educate consumers about how to get benefits they may not know they already have, especially if they are Regence members.”

Illinois

1) Health Care Service Corporation: $4,453,694,156

2) Kaiser: $755,233,529

3) UnitedHealthcare: $650,127,413

miEdge’s Mark Smith pointed out the “substantial market-controlled presence in Illinois” for Health Care Service Corp, a Blue Cross franchise. The carrier’s nearly $4.5 billion in in-force premium is many times more than the premium of the second largest carrier, Kaiser. In March, HCSC announced the company is pledging $1.5 billion over three years to reducing healthcare costs for its members in an initiative called Affordability Cures. “Across the board, there’s still work to do,” said Paula Steiner, president and chief executive officer. “Moderating premium increases year-to-year is relative. Long-term, sustained rate reduction is only achievable when all stakeholders work together to create a stable market for affordable coverage that works for our customers. Many people struggle to afford health insurance. We owe it to them to find solutions with staying power that aim for what has eluded us as a nation — and that’s what Affordability Cures is all about.”

Indiana

1) Anthem: $425,271,156

2) UnitedHealthcare: $145,164,864

3) Cigna: $43,412,354

Anthem is investing $20 million into revamping its downtown Indianapolis headquarters, the company announced May 22. The completed complex will house more than 2,600 employees by the end of the year. “Indianapolis has been Anthem’s home since our company was founded nearly 75 years ago,” President and Chief Executive Officer Gail Boudreaux said. “Our employees live and work here, and we are part of the community."

Kansas

1) Blue Cross and Blue Shield of Kansas: $493,104,437

2)UnitedHealthcare: $80,179,626

3) Aetna: $67,471,689

In April, Matt All became the eighth president and CEO in Blue Cross and Blue Shield of Kansas’s 76-year history. He is a native Kansan who has been with the company since 2006. "I am deeply honored to work on behalf of our members in communities across the state," All said. "Alongside our 1,600 employees, I plan to carry on our 76-year commitment to providing Kansans peace of mind and access to a better quality of life."

Kentucky

1) Anthem: $395,798,552

2) Humana: $137,403,987

3) UnitedHealthcare: $75,856,138

Last year, prescribed opioids for members of Anthem Blue Cross and Blue Shield in Kentucky dropped by 12% for individual and employer-sponsored members. “As a health insurer, we have a responsibility to do what we can to address this health epidemic and we are committed to making a significant difference to our members,” said Deb Moessner, president of Anthem Blue Cross and Blue Shield in Kentucky. “We believe these changes in pharmacy policy, complemented by a broad set of strategies addressing the opioid epidemic, will help prevent, deter and more effectively treat opioid use disorder among our members.”

Louisiana

1) BlueCross BlueShield of Louisiana: $365,469,870

2) UnitedHealthcare: $194,466,374

3) Humana: $68,525,700

A Blue Cross and Blue Shield of Louisiana grant-funded program launched in April that gives high school students in the East Baton Rouge Parish School System the opportunity to learn more about prescription drug safety and misuse. The Prescription Drug Safety Network is a national program. “The national opioid epidemic is an acute public health issue in Louisiana, and we are doing our part to help all state residents lower their risks,” said Michael Tipton, head of community relations for Blue Cross and Blue Shield of Louisiana and president of the Blue Cross Foundation. “With this program, we have an opportunity to raise awareness with students that prescription drugs, when not used properly, are as dangerous as street drugs. And, we’re hoping there will be a positive ripple effect, as these students share what they learn with their families and can help others stay safe.”

Massachusetts

1) Blue Cross Blue Shield of Massachusetts: $2,625,587,659

2) Harvard Pilgrim Health Plan: $596,519,086

3) Tufts Health Plan: $306,860,906

Blue Cross Blue Shield of Massachusetts, Inc. and Blue Cross Blue Shield of Massachusetts HMO Blue, Inc. on May 15 reported a combined after-tax first quarter net income of $57.5 million (2.9% net margin) on revenue of $2.0 billion. "Our first quarter results are consistent with our expectations," said Andreana Santangelo, Blue Cross' chief financial officer. "They reflect a highly competitive marketplace, reinforcing the need for us to continue to effectively manage both administrative and medical spending while continuing to offer exceptional, affordable health plans to our employer customers and members."

Maryland

1) UnitedHealthcare: $533,814,653

2) CareFirst BlueCross BlueShield: $519,932,388

3) Kaiser: $407,393,063

In its annual “Wellness Check Up Survey,” released May 22, UnitedHealthcare found 53% of people with access to wellness programs said the initiatives have made a positive impact on their health. “This year’s results underscore the importance of workplace wellness programs, which can encourage well-being, prevent disease before it starts and, as a result, help lower medical costs,” said Rebecca Madsen, UnitedHealthcare chief consumer officer.

Maine

1) Anthem: $566,973,214

2) Harvard Pilgrim Health Plan: $56,380,892

3) Aetna: $47,422,294

In the first quarter of 2018, Anthem’s profits increased 30%, to $1.3 billion, compared to the first quarter of 2017, according to its April earnings report. "We are pleased with our first quarter 2018 financial performance, which reflects our commitment to strong medical cost performance by effectively leveraging community based innovative and integrated clinical and value-based care models across our markets," said Gail Boudreaux, Anthem president and CEO.

Michigan

1) Blue Cross Blue Shield of Michigan: $1,760,149,818

2) Health Alliance Plan of Michigan: $562,563,672

3) Priority Health: $539,634,445

The Michigan Blues in March announced increased membership for the seventh consecutive year, adding 54,862 customers across all of its products — which include Blue Cross Blue Shield of Michigan health plans, Blue Care Network of Michigan health maintenance plans and Blue Cross Complete of Michigan. The company reported a positive operating margin of $385 million on revenue of $26.9 billion. “We are keeping margins on health insurance low, but profitable,” Blue Cross President and CEO Daniel Loepp said. “We saw a significant increase in small employer membership in 2017, resulting from our efforts to moderate prices for small businesses. And we are diversifying our revenue streams, growing business outside of health insurance and maximizing returns from investments, to keep health coverage affordable.”

Minnesota

1) Medica: $335,507,612

2) HealthPartners: $310,703,786

3) Blue Cross and Blue Shield of Minnesota: $235,452,662

Dr. John R. Mach, Jr. joined Medica in November as chief medical officer to provide leadership in quality management, clinical review and quality of care initiatives. “Dr. Mach is a highly respected physician who is also an accomplished health care executive with extensive clinical and business expertise,” said John Naylor, Medica president and chief executive officer. “He has a passion for driving large-scale clinical, quality and cost improvements for a wide range of populations. I have great confidence in his ability to bring continuous improvement to the clinical care provided to our members as well as the service delivery provided at the site of care.”

Mississippi

1) Blue Cross & Blue Shield of Mississippi: $104,675,372

2) UnitedHealthcare: $37,824,937

3) Cigna: $3,940,709

Blue Cross & Blue Shield of Mississippi and St. Dominic Hospital in March announced a telehealth services partnership to support local, community-based care. “This partnership is another example of our efforts to remove barriers to care for Mississippi patients by facilitating continuity of care from Blue Primary Care Network Providers to coordinated specialty care without having to travel long distances,” said Dr. Tom Fenter, chief medical officer at Blue Cross & Blue Shield of Mississippi. “St. Dominic’s approach is unique in that they provide telehealth services in addition to, and not in place of, in-person patient visits.”