Blue Cross & Blue Shield of Rhode Island

2016
Annual Report

Advancing the overall health of our state

What does simple and affordable healthcare mean for Rhode Island?

Healthier individuals and families. An improved quality of life. A stronger economy. At Blue Cross & Blue Shield of Rhode Island, that’s what we want for our state—and we made great strides toward it in 2016.

Our collaborations with the state’s leading healthcare providers have delivered improvements in quality and cost. Thanks to those efforts, more than half of our members see a primary care provider who coordinates their care with specialists and hospitals—a model we call “systems of care.” This improved coordination has reduced emergency room visits and unnecessary procedures as well as significantly improved members’ experience within the healthcare system.

In 2016, we also introduced new technology that makes healthcare easier. Our data analytics platform, Blue Insights, enables primary care providers and employers to make more informed healthcare decisions. And our partnership with Virgin Pulse® gives our customers the industry-leading wellness tracking and incentive technology.

As a local not-for-profit, we’re committed to keeping all Rhode Islanders healthy. We’re fortunate to be part of—and give back to—such a strong, caring community. Last year, we supported more than 200 organizations and donated over 8,000 volunteer hours through our BlueAngel Community Investment program.

Despite these accomplishments, Rhode Island continues to rank among the most expensive places in the country to receive healthcare services. Those high costs, in turn, drive the cost of insurance premiums. That’s why we must accelerate the adoption of systems of care by providers and patients, innovate lower cost insurance coverage options for employers and individuals, and enable consumers and providers to easily access information about healthcare choices and costs. These actions will help us achieve the “triple aim” of better health for our state, a simpler patient experience, and lower costs.

No matter the challenges that may be ahead, we’ll continue to lead the way for our friends and neighbors in Rhode Island.

Kim A. Keck

President and
Chief Executive Officer

Randy A. Wyrofsky

Board Chair

Expanding the systems of care approach

When we collaborate with physicians to increase coordination of care, quality can go up and costs can come down.

Managing care proactively

In our systems of care approach, primary care providers coordinate their patients’ care with specialists and hospitals. It’s a model that, in 2016, improved quality and helped control costs. For example, these systems of care reduced trips to the emergency room for our members who struggle with diabetes. These patients also had a more positive experience within the healthcare system by avoiding unnecessary services such as lab tests and emergency room visits. With strong evidence that these collaborations are successful, BCBSRI is committed to expanding these arrangements in the coming years.

15%

Fewer trips to the emergency room for members with diabetes

40%

Rhode Island physicians who will be collaborating within our systems of care in 2018

Accelerating the coordination of patient care

Over the past few years, we have expanded our systems of care approach with the state’s leading providers. In 2016 alone, through our agreement with Integra Community Care Network, we made coordinated healthcare available to 60,000 of our members. In a first for Rhode Island, eight new primary care centers strategically located across the state now provide same-day care for patients with urgent care issues. This builds on previous collaborations with Lifespan and CharterCARE Health Partners.

228,480

BCBSRI members who are in systems of care

Delivering lower cost solutions

We’re guiding customers to coverage options that can lower premiums and overall costs—and help members stay healthy.

Encouraging smarter health decisions

To attract talented employees, businesses in Rhode Island need great benefits, like the customized wellness platform we began offering in 2016. Designed by Virgin Pulse for mobile, desktop, and wearables, it helps employers cultivate healthier habits for their employees. For example, the platform uses gaming techniques to engage users in activities that promote healthy behaviors. Participation by employees, including BCBSRI associates, improves workplace culture, increases productivity, and boosts overall employee wellness through better nutrition, sleep, and activity levels. This, in turn, can lower medical costs and improve business outcomes.

Learn more about BCBSRI and Virgin Pulse.

“I’m so pleased that Virgin Pulse will be partnering with the largest health plan in Rhode Island to bring healthy habits and positive change to our state.”

—Dr. Rajiv Kumar, President and Chief Medical Officer, Virgin Pulse

Innovating lower cost solutions

In 2016, we continued to encourage employers and individuals to choose options that lower premiums and overall costs without sacrificing quality. Consumer-driven health plans, with health savings accounts (HSAs), promote smarter healthcare decisions and can reduce costs to businesses. In our BlueCHiP family of plans, a primary care provider guides all of a member’s care, which can improve quality and control cost. We are committed to helping more businesses and members choose these types of plans in the coming years. By moving Rhode Islanders toward these options, BCBSRI is helping to make healthcare more affordable.

50,000

Potential savings each year for a small business choosing a consumer-driven health plan

Providing data to inform decision-making

Our Blue Insights platform gives doctors and employers data so everyone can make informed decisions.

Enabling better healthcare information

Having instant access to information allows us to make smart choices on everything from restaurants to airline tickets. At BCBSRI, we believe the same should be true for healthcare. Doctors, employers, and patients should be able to access data on the quality and cost of specific healthcare services so they can make more informed decisions. This is especially important with the delivery of specialty services, which account for 70% of total healthcare costs. Members can save money by comparing prices on services with comparable quality outcomes and choosing the lower cost provider. By 2018, 100% of systems of care providers will have access to quality and cost data on specialists like cardiologists and dermatologists. This enables systems of care providers and their patients to make more informed healthcare decisions.

Learn more about Cost Calculator and other tools to help members make informed choices.

Helping members manage out-of-pocket costs

Cost comparison tools available to our members help identify opportunities to save on common procedures.

$1,203

Range of estimated average costs for abdominal CAT scans* in Rhode Island

$411 to $1,614

*Estimated average costs are not an exact calculation of actual costs and do not reflect all of the terms, conditions, limitations and exclusions that may apply to coverage. Members’ actual costs will vary depending upon the specifics of the benefit plan and the particular services and/or supplies received.

Creating better insights, better health

Blue Insights, the data analytics platform introduced by BCBSRI in 2016, allows healthcare professionals to access and analyze data for individuals and entire patient populations. With Blue Insights, providers are able to:

  • Access patient care data, allowing better management for patients with complicated health problems.

  • Monitor patients with ongoing conditions to ensure that tests and appointments are kept and that prescriptions are filled.

  • Detect emerging health concerns among their patient populations.

Blue Insights benefits employers as well, enabling them to choose health plan designs that integrate workforce wellness while lowering healthcare costs. A web-based reporting tool offers automated reports that can be used to track network performance, inpatient and outpatient activity, and total costs of care. Employers can use the data to modify their plan at renewal to include lower cost network products, consumer-driven plans, or increased incentives for wellness.

Learn more about our Blue Insights data and analytics platform.

BlueAngel Community Investment program

We continue to fulfill our mission to improve the health of our Rhode Island communities.

Teaming up for a healthier Rhode Island

Through our BlueAngel Community Investment program, we support nonprofit organizations whose programs address critical health issues facing Rhode Islanders. In 2016, our signature investments focused on:

  • Addressing the issue of childhood obesity by forming and continuing strategic partnerships committed to increasing healthy behaviors and creating enhanced awareness around this issue

  • Funding clinics that provide free and low-cost services to the uninsured and the underinsured

  • Increasing health literacy among Rhode Islanders through community programs that help people understand the system and get the most from their healthcare

Giving back through volunteerism

Our employee volunteers are enthusiastic champions of our community investment efforts throughout the year. In 2016 alone, BlueAngel volunteers donated over 8,000 hours to more than 50 organizations in Rhode Island. Additionally, associates at all levels of the company serve on more than 40 local nonprofit organization boards.

How we helped our communities in 2016

215

Organizations that BCBSRI supported through in-kind donations, volunteerism, or financial support

8,036

Hours that BCBSRI employees volunteered

$189,346

Value of the hours that BCBSRI employees volunteered*

*Independent Sector used to determine value of a volunteer hour

$128,385

Charitable donations raised through employee fundraising

$1,149,679

Invested by the company through financial or in-kind donations

2016 Financial Report

While 2016 was a challenging year, it reinforced our need to better control healthcare costs while facilitating the delivery of quality healthcare.

The rising use of medical services and high-priced specialty drugs resulted in a net loss of $34.53 million, despite achieving our lowest administrative cost to premium ratio (12.8%) since 2008.

Our playbook for evolving how healthcare is delivered and paid for—incorporating collaborative care, lower cost coverage options, and more informed providers and patients—made good headway in 2016, especially in the second half of the year, and we will continue that progress through 2017.

Here is a detailed look at how the company performed in 2016.*

Revenue

In 2016, we recorded $1.71 billion in premiums from members (individuals and employers). We also earned $2.53 million in investment revenue.

$1,714,136,000

Premium Revenue

+ $2,525,000

Investment Revenue

$1,716,661,000

Total Revenue

Expenses

From total revenue, $1.48 billion was used for medical and dental claims for our members. This amount accounted for 86.3% of premium revenue collected. The company spent $219.85 million on expenses to support the core operations of our business, or 12.8% of premiums. An additional $51.43 million was spent on other expenses, including $36.13 million on assessments required by the Affordable Care Act.

$1,479,912,000

Payments to Providers

+ $219,852,000

Administrative Expenses

+ $51,429,000

Other Expenses

$1,751,193,000

Total Expenses

Net Loss

Overall, while total revenue stood at almost $1.72 billion, expenses exceeded $1.75 billion in 2016, driven by increases in payments to healthcare providers, resulting in a net loss of $34.53 million.

($34,532,000)

Net Loss

Premium Reserves

In 2016, premium reserves that we held for the protection of our members totaled $266.47 million at year end.

$266,471,000

Premium Reserves 12/31/2016