(Section 1) 2019 Annual Report — CEO Letter

Her Background

It’s What
We Live For

Blue Cross & Blue Shield of Rhode Island celebrated our 80th year in 2019 as a proud Rhode Island company with deep roots in the community. This annual report reflects progress made toward our North Star—passionately leading a state of health and well-being across Rhode Island.

What does that mean?

First, affordability remains our number one goal. We recognize that healthcare is still too expensive, and costs are still rising too quickly. With a third consecutive year of strong financial results, we are well positioned to invest in more affordable care that delivers better outcomes for Rhode Islanders.

On the policy front, as a leader of the state’s Health Care Cost Trend Steering Committee, we helped set a goal to curb Rhode Island’s increase in healthcare costs to no more than 3.2% annually, an important step—and one that only two other states have taken. Mobilizing our resources to lead advocacy for reinsurance in the individual market created lower premiums for individuals buying their own plans. And we announced the first round of grants from the Behavioral Health Fund at the Rhode Island Foundation, totaling $2.7 million to six organizations addressing issues ranging from transportation to trauma.

At a more granular level, we continue working with employer and provider partners to control costs, offering practical products and services that save money without sacrificing quality of care. You’ll read here how members in our patient-centered medical homes have seen their healthcare costs decrease in the past decade—evidence that these partnerships are paying off for Rhode Islanders.

 

Beyond affordability, we are committed to transforming the way Rhode Islanders experience healthcare. Adding a fourth Your Blue StoreSM location, in Cranston; introducing Your Blue Bus, a mobile retail store; and expanding Doctors Online to include behavioral health were just a few ways we created convenience for our members.

We were particularly proud to introduce an innovative care delivery model to Rhode Island, in collaboration with Oak Street Health. Three Oak Street Health centers opened in 2019, with 429 members by year-end. Patient and community response to the personalized, wraparound Oak Street model far surpassed expectations.

Finally, continuing to transcend the traditional role of payer with a focus on improving the health of all Rhode Islanders, we launched the game-changing RI Life Index, which has built awareness of the impact of social determinants on Rhode Islanders’ health. The Index inspired us to refocus our BlueAngel Community Health Grants on the intersection of housing and health.

We thank you for your support and trust, and especially for your partnership.

It's what we live for.

Kim A. Keck, President and CEO, BCBSRI

Kim A. Keck
President and CEO, BCBSRI

 

John C. Langenus, Board Chair, BCBSRI

John C. Langenus
Board Chair, BCBSRI

(Section 2) 2019 Annual Report — Affordability

Collaboration drives cost-control efforts

Partnerships with state, industry leaders aim for higher quality, lower costs

Affordability hero

Targeting costs to drive a state of well-being

BCBSRI has taken a leadership role in supporting the state’s effort to slow the growth of medical spending in Rhode Island.

Kim A. Keck, BCBSRI President and CEO, co-chaired a special committee to address rising costs. That led to a 3.2% target in medical spending growth, which Governor Gina Raimondo signed as an executive order in February 2019. Achieving the target will allow the state to spend on other key priorities critical to Rhode Island’s economic vitality.

BCBSRI is firmly committed to leading policy efforts that will drive a state of health and well-being across Rhode Island.

 

Rhode Island Health Care Cost Trends Steering Committee co-chairs:
  • BCBSRI President and CEO Kim A. Keck
  • Coastal Medical President and CEO Dr. Al Kurose
  • Rhode Island Health Insurance Commissioner Marie Ganim

 

 

Blue Cross is proud to be a leader in these efforts, which position Rhode Island at the forefront of a critical national issue.
Kim A. Keck
,
BCBSRI
,
President and CEO

Medical Spending Cap

Offering new Options to employers

 

Our newest offering, Network Blue New England Options, provides employers with a way to give employees more control over their healthcare costs.

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In this plan, PCPs and hospitals are placed into one of two levels, Standard or Enhanced, to help members make better informed healthcare choices. Providers in both groups deliver the quality you would expect within a BCBSRI network. Those at the Enhanced level can offer a better experience, both in terms of care and cost savings. Members can save money by choosing providers in the Enhanced level, while employers also can save with lower premiums.

The Options plan adds to the suite of popular regional plans launched in 2017 that are designed to expand access and lower costs.

 

 

 

52% Chart

 

growth in the past year in regional plan members

Delivering greater value with Total Care

Employers know the importance that employees place on high-quality, affordable care. So they appreciate BCBSRI's commitment to shift provider payments from traditional fee-for-service to value-based care, where providers are paid for better patient outcomes, not for number of services performed.

Our market-leading value-based care model, Total Care, is designed to improve the health of members and curb the rising cost of healthcare.

Quite simply, doctors are paid for their ability to help our members be healthier.

The results? Improved management of chronic conditions, increases in preventive screenings, and lower annual cost increases. In fact, if a member has been receiving care from a patient-centered medical home (PCMH) since 2011, their annual healthcare costs have decreased by $228, on average, since that time.1

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$228

If a member has been receiving care from a patient-centered medical home (PCMH) since 2011, their annual healthcare costs have decreased by $228, on average, since that time.1

Delivering Greater Care

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27%

fewer inpatient
hospital admissions2

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40%

lower overall cost
trends since 20151

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$35,000,000

saved for self-insured RI employers
since 20171

1 BCBSRI internal analysis of accountable care and patient-centered medical home providers compared to standard providers, 2011–2018
2 BCBSRI analysis of 2018 National Committee for Quality Assurance’s Healthcare Effectiveness Data & Information Set

 

 

Collaborating with providers for higher quality, lower costs

Working with University Orthopedics, we launched another value-based care program in 2019—a “bundled payment” model that can help reduce overall healthcare costs while setting quality benchmarks.

This model establishes a single cost for all of the services performed in a “bundle” for outpatient hip, knee, and shoulder surgeries. The bundle includes a range of services, from surgery to post-op exams and nursing care to physical therapy. It is designed to move surgeries from hospitals to University Orthopedics’ Kettle Point surgical center in East Providence.

This agreement—and the shift away from charging fees for every individual service—is an important step in our efforts to make healthcare more affordable for Rhode Islanders. Equally important is the commitment of both organizations to tie in quality measures to ensure that patients are getting the best possible care.

 

 

This partnership with Blue Cross allows our patients optimal access to a multitude of services while also focusing on convenience for our patients.
Dr. Edward Akelman
,
University Orthopedics
,
President
Collaborating with providers for higher quality, lower costs

Rewarding employers with innovative incentives

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$300,000+

 

More than $300,000 projected payout in first year of the program

In 2019, we created new ways to help employers control costs, including the launch of the Wellness Premium Reward program. In this initial version of the program, businesses with fewer than 50 employees can earn back up to 8% of their total annual medical premium. A typical 25-employee company could earn as much as $25,000 in rewards each year.

With Wellness Premium Reward, the first program of this type in the state, we give employers another way to reduce their costs—and make it easier to engage employees in activities that can deliver better health.

The program allows employees to participate in wellness activities like tracking steps, learning health and wellness tips, and scheduling screenings. Employees at small businesses can earn up to $200 in rewards.

 

At London Health, we feel we are now in more control of our healthcare costs, while at the same time rewarding our employees for their participation in healthy activities.
Christopher Cote
,
London Health Administrators
,
Managing Director
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Watch "Building a Healthier Future with BCBSRI"

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(Section 3) 2019 Annual Report — Customer Convenience

New tools empower members

Customer focus enhances benefits, informs decision-making

Customer Convenience Photo

Helping older Rhode Islanders with new benefits

Our new Medicare Advantage benefits focus on making life easier for older Rhode Islanders. Along with many $0 features, we added benefits that members have been asking for, such as hearing aids, acupuncture, and reimbursement for wellness activities.

Significantly, members can now receive rides to and from doctor appointments, and they can receive meals delivered to their homes after a hospital stay. All at no extra cost. Features like these help members stay healthy and stay independent.

Most plans now include dental benefits too, so members don’t need to worry about buying dental insurance separately.

$0

Icon   gym membership

$0

Icon   Doctors Online visits1

$0

Icon   generic drugs in Tiers 1 & 22

$0

Icon   rides to the doctor3

$0

Icon   meals delivered3

$0

Icon   Routine vision/hearing visits

1 Doctors Online is a telemedicine service provided by American Well®, an independent company that administers Doctors Online on behalf of Blue Cross & Blue Shield of Rhode Island.
2 Available through mail order for all members except BlueCHiP for Medicare Core (HMO)
3 Conditions apply

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Watch "A Whole Lot of Medicare Benefits for $0"

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Creating more places for members to get help

With our fourth Your Blue StoreSM, in Cranston, we have continued to give Rhode Islanders greater access to help and more places to gather with friends and fellow members.

They can ask our team questions about their plans face-to-face. They can speak to a nurse, nutritionist, or case manager about their health. And they can join their friends in a fitness class, anything from circuit training to yoga to Zumba. The Cranston store joins our locations in East Providence, Lincoln, and Warwick.

We have even taken the store on the road with Your Blue Bus. Like the stores, this unique customer service tool is another way to help members with their plans and their health.

Bus

Members can follow the bus by following the hashtag:

#YourBlueBusRI

 

64,061
Your Blue Store visits

Arrow24% increase from 2018

19,228
class attendance

Arrow 25% increase from 2018

2,390
fitness classes offered

Arrow 24% increase from 2018

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Giving members the information they need

To help our members make better informed decisions about their healthcare, we introduced new performance ratings for primary care providers (PCPs) in the BCBSRI network. The ratings, based on quality and cost efficiency, appear in our online Find a Doctor tool.

For quality, the ratings represent how often patients are successfully treated and how often providers follow best practice performing preventive screenings for diseases such as breast cancer and diabetes. For cost efficiency, the ratings compare the average cost-per-patient for PCPs. We adjust the measure based on the mix of patients each provider treats.

We are continuing to release convenient tools for members that are designed to inform their decisions.

Giving members the information they need
Expanding access to convenient care

 

 

Expanding access to convenient care

BCBSRI has expanded its telehealth platform, Doctors Online, to offer behavioral health services. Doctors Online previously gave members access to board-certified doctors for non-emergency medical issues 24 hours a day, seven days a week, on a phone, tablet, or computer.

Now members can also schedule appointments with a licensed therapist or board-certified psychiatrist for an added level of access and convenience.

Adding behavioral health is an important next step in our efforts to improve access to behavioral health services for our members. Many people may not have the time to travel to appointments from work or home. Through Doctors Online, our members can access behavioral health appointments from any place that is convenient and comfortable for them.

Doctors Online

(Section 4) 2019 Annual Report — Health & Well-Being

Data opens up new possibilities

Initiatives reveal opportunities and deliver solutions

Health and well-being hero image

Illustrating statewide needs with the RI Life Index

Underscoring our commitment to building and leading a healthier state, we created the RI Life Index in 2019. This new annual data resource, developed in partnership with the Brown University School of Public Health, measures Rhode Islanders’ perceptions of the social factors influencing health and well-being in the state.

The results offer a first-of-its-kind window into what Rhode Islanders think are significant health challenges as well as community strengths.

Strengths

The RI Life Index showed strengths in areas such as:

• Access to affordable, nutritious food
• Availability of safe, reliable transportation
• Programs and services available for children

Challenges

In contrast, residents, especially those in Rhode Island's most economically challenged cities, had lower perceptions of:

• Availability of quality affordable housing
• Job opportunities
• Job training programs

“As many residents of Rhode Island already know, social determinants of health, such as the cost of housing and employment issues, often make it incredibly challenging for many families to experience the highest quality of health and well-being.”

 

—Melissa Clark, Ph.D., Professor of Health Service, Policy, and Practice, and Director of the Survey Research Center at the Brown University School of Public Health

Image Providence

 

With this data, BCBSRI is working with community partners to develop new approaches to address these issues, particularly the lack of affordable housing. As a first step, at the end of 2019 we made grants totaling $200,000 to the following five organizations working to raise awareness of the impact of social factors on health, particularly access to safe, healthy, affordable housing:

See our Community Investment Report for more details on our efforts to address life factors influencing health and well-being.

Learn more about the RI Life Index

Opening the door to a new model of care

Our Medicare Advantage members are loving the new primary care centers that we worked with Oak Street Health to open in Rhode Island. The Oak Street Health model helps members understand and maximize their Medicare benefits, stay healthy, remain active and social, and retain their independence.

 

Icon  JR and Carmina: "The place is phenomenal"

Members can now choose a PCP from any of three Oak Street Health centers, two in Providence and one in Warwick, where they will find:

  • A dedicated care team who takes extra time to get to know each person
  • Same-day or next-day appointments
  • Shorter wait times
  • Transportation to and from appointments for eligible patients
  • Onsite and telehealth behavioral health specialists
  • 24/7 telephone support
  • Community activities and events
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Changing Direction on mental health

We have expanded the ways our members can get help with mental health and substance use disorders. We’ve added therapists to our Doctors Online telehealth service and increased access to pediatric behavioral healthcare. Just as important is the effort to “change direction” on mental health.

BCBSRI was the first insurer in Rhode Island to pledge support to the statewide implementation of the Campaign to Change Direction. This national initiative aims to change the culture of mental health so everyone receives the care they need and deserve. The Campaign encourages everyone to pay attention to their emotional well-being, and it reminds us that emotional well-being is just as important as physical health.

Campaign to Change Direction

Changing Direction on mental health
Stepping up the Challenge

 

 

Stepping up to the challenge

More than 1,300 older adults tracked their steps and their physical activity in support of senior centers across the state—all part of BCBSRI’s first-ever Step Up Challenge. Our friendly competition not only motivated participants to maintain or increase their own physical activity, but also helped three senior centers each earn a $2,500 grant for health and wellness activities:

  • North Providence Mancini Center
  • Benjamin Church Senior Center
  • Cranston Senior Enrichment Center

 

The Step Up Challenge began on September 1 with kickoff walks in Warwick, Bristol, and Lincoln. In all, 20 senior centers participated in the challenge.

 

Icon 141,780,081

Step Up Challenge steps

 

 

Teaming up to reduce medication problems

BCBSRI has partnered with Brown Emergency Medicine to reduce problems caused by prescription drugs for Rhode Island seniors. The pilot program specifically aims to improve the way seniors are prescribed medications when they leave emergency departments. The EQUIPPED program, short for Enhancing Quality of Prescribing Practices for Older Adults Discharged from the Emergency Department, intends to reduce preventable problems.

The program was one of the winning submissions from BCBSRI’s Provider Medical Expense Trend (MET) Summit. The Summit invited proposals to reduce rising and unnecessary medical costs.

Beyond keeping Rhode Island’s seniors healthier, EQUIPPED is also expected to provide education to emergency department physicians on medication safety and to lower costs by reducing adverse drug events.

Hear Elizabeth Goldberg, M.D., ScM, Assistant Professor of Emergency Medicine at Brown University, explain EQUIPPED.

Partnering to reduce medication problems
Fostering Safe Zones for LGBTQ care

 

 

Fostering Safe Zones for LGBTQ care

BCBSRI certification of Safe Zones continues to expand—now at 29 sites—making it easier for members in the LGBTQ community to find safe, affirming, and inclusive care.

The list of Safe Zone providers now includes assisted living for older adults.

Certification requirements include:

  • Staff training specific to the care of trans* and LGBTQ people
  • Protection for patients and staff from discrimination based on gender identity or expression
  • Gender-neutral bathrooms
  • Inclusive forms and procedures

Trans* is an umbrella term that refers to all of the identities within the gender identity spectrum.

We list all certified BCBSRI LGBTQ Safe Zone practices on our website.

Learn More

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Top 4 Percent

Rating in the top 4% of plans nationwide

For the fifth straight year, our efforts to improve our members’ healthcare experience have helped us earn a 4.5 (out of 5) rating for our preferred provider organization (PPO) products. The rating of BCBSRI PPO products is part of the Private Health Insurance Plan Ratings for 2019-2020.

That puts our PPO plans in the top 4% nationally. The rating comes from the National Committee for Quality Assurance (NCQA), which rated 274 PPO plans.

 

1 of 12 plans

nationally with a score of 4.5 or higher

(Section 5) 2019 Annual Report — Financials

Financials

One-time events drive positive results, allow investment in the health of RI

Financials hero photo

Our 2019 financial performance contributes to our ability to invest in the health of Rhode Island. The new Oak Street Health community-based model of care is just one example of a BCBSRI partnership focusing on life factors that influence health, like safe and affordable housing, transportation, and healthy food—needs identified through the RI Life Index. We are committed to investing in these critical areas to build healthy communities throughout our state. The after-tax net gain of $69 million was driven by several factors, including a federal tax refund that was a result of a change in federal tax law, one-time investment gains, and lower-than-expected medical costs, which are not expected to continue in 2020.

 

Overall Profit/Loss

For the third consecutive year, we have shown positive financial results, allowing us to contribute $69 million into reserves, money we set aside for the protection of all our members to pay future claims.

$68,834,000

Revenue

In 2019, we recorded $1.70 billion in premiums from members (individuals and employers). We also recorded a $21 million gain on investment revenue.

$1,698,166,000
Premium Revenue

+ $20,991,000
Investment Revenue

$1,719,158,000
Total Revenue

*Numbers may not add up due to rounding.

Expenses

BCBSRI spent $1.44 billion for medical and dental claims for our members. This accounted for 84.6% of premium revenue collected. The company spent $223.5 million (including premium taxes) on expenses to support the core operations of our business, or 13.2% of premiums. An additional $27.1 million was spent on other expenses, including $3.2 million on assessments required by the Affordable Care Act. The company also recorded a $36.3 million offset to expenses for the first installment of the Federal Tax Refund.

$1,435,931,000
Payments to Providers

+ $223,528,000
Administrative Expenses

+ $27,123,000
Other Expenses

- $36,258,000
Federal Tax Refund

$1,650,324,000
Total Expenses*

*Numbers may not add up due to rounding.

Net gain

Overall, total revenue stood at just over $1.70 billion, and expenses exceeded $1.65 billion in 2019, resulting in a net gain of $68.8 million.

$68,834,000

Premium Reserves

In 2019, premium reserves that we held for the protection of our members totaled $372 million at year end.

$371,584,000

Premium Reserves as of 12/31/2019

This formulation represents unaudited results utilizing Statutory Accounting Principles. The Blue Cross and Blue Shield Association licenses Blue Cross & Blue Shield of Rhode Island to offer certain products and services under the Blue Cross and Blue Shield brand names. Blue Cross & Blue Shield of Rhode Island is an independent organization governed by its own Board of Directors and solely responsible for its own debts and other obligations. Neither the Association nor any other organization using the Blue Cross and Blue Shield brand names acts as a guarantor of Blue Cross & Blue Shield of Rhode Island’s obligations. A copy of Blue Cross & Blue Shield of Rhode Island’s most recent audited financial statements is available on request to: Blue Cross & Blue Shield of Rhode Island, 500 Exchange Street, Providence, RI 02903.