These are the most profitable BCBS plans

Plus: Sen. Sanders to vote against Biden on NIH pick

Oct 27, 2023

Good morning and happy Friday. Welcome to your weekly e-newsletter, the Friday Pulse Check from Fulcrum Strategies.

In the news:

Sen. Sanders to vote against Biden’s NIH nominee

Last week, I shared that Senator Bernie Sanders (I-VT) had some interesting questions for President Joe Biden’s pick to run the National Institutes of Health. He immediately began questioning Dr. Monica Bertagnolli about the cost of prescription drugs and the role of the pharmaceutical industry in making healthcare decisions. “Dr. Monica Bertagnolli is an intelligent and caring person, but has not convinced me that she is prepared to take on the greed and power of the drug companies and health care industry,” he said in a statement. The NIH has virtually no say when it comes to the cost of prescription drugs. Dr. Bertagnolli’s confirmation is expected to pass with Republican support. Read more in the Hill.

Limited supply of new RSV puts doctors on notice

There is a limited supply of both the RSV vaccine and a new antibody drug intended to treat the disease and providers are taking note of new instructions from the CDC on how to ration it. Sanofi, which makes the RSV drug, said they have an “aggressive supply plan” but said the demand was more than they could currently handle. Read more in Axios.

The most profitable BCBS companies in the first half of 2023

Blues push OMB to collect more data to back equality efforts

In a report obtained by Becker’s Payer Issues, BlueCross BlueShield Association companies are doing quite well on their own, even the non-profit organizations. Two plans, however, are facing deficits of over a million dollars. Here are the top 10:

Elevance Health (14 plans) - $3.2 billion
Health Care Services Corporation (5 plans) - $1.2 billion
Florida Blue - $408 million
BlueCross BlueShield of Tennesee - $286 million
Highmark (6 plans) - $283 million
BlueShield of California - $259 million
Wellmark BlueCross BlueShield - $208 million
BlueCross BlueShield of Michigan - $206 million
Independence BlueCross - $146 million
BlueCross BlueShield of Louisiana - $127 million

BlueCross BlueShield of North Carolina came in at no. 13. See the complete list on Becker’s Payer Issues.

LIVE Elevance stock price: ELV 0.00%↑

Letting doctors be doctors

This week on the FLATLINING Podcast from Fulcrum Strategies, Ron and I discussed two articles of interest. First, for our clients and listeners in North Carolina, we talked about the recent news that BlueCross BlueShield of NC would purchase all NC locations of the FastMed retail healthcare chain. We talked about how this might affect patient access and what it means for competing providers.

We also talked about a recent phone call Ron had with a managed Medicaid organization on behalf of one of his clients. This particular managed Medicaid organization really wanted Ron’s client to take on risk.

I had to have Ron hold up there and explain what risk means in the healthcare world. In the auto industry, a risk would be a driver with a bad record or in the life insurance industry, an older man who smokes a pack of cigarettes a day. So what does that mean in health insurance? Ron explains and also talks about why downside risk should be avoided by providers when approached by insurance carriers.