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Business Highlights: Health Plans

Highmark Direct store

Highmark is well prepared to meet the needs of individual customers at its 10 Highmark Direct stores located in western and central Pennsylvania.

New markets, channels and tools satisfy customer needs

In 2014, the health plans embarked on a brand new way of selling insurance by participating in the public marketplace (exchange) in Pennsylvania, Delaware and West Virginia made available through the Patient Protection and Affordable Care Act (ACA). The new marketplace is geared toward helping individuals purchase plans that best fit their needs. Given Highmark's longstanding history of providing consumers with high-quality health care in an understandable way, the health plans were well positioned to thrive in the new marketplace. A total of more than 343,000* people purchased coverage on the marketplaces through Highmark or Highmark-affiliated health plans in Pennsylvania, West Virginia and Delaware.

Highmark was well prepared to meet the needs of individual customers, in part, because of the established community presence of its Highmark Direct stores. In its 10 stores, which are located in western and central Pennsylvania, licensed associates offer personalized assistance, in a comfortable, private office setting, to people in need of the right health insurance policy. Store hours were expanded during 2014, area producers were invited to sell at the stores and bilingual staff assisted customers. In addition, Highmark's popular mobile units engaged community members with educational programs and on-site technology to facilitate health plan registration.

Highmark Blue Cross Blue Shield Delaware and Highmark Blue Cross Blue Shield West Virginia both expanded into the Medicaid managed care market in 2014, further supporting the health plans' mission to provide high-quality, accessible health insurance options to the communities they serve. Highmark Delaware created a wholly-owned subsidiary, Highmark BCBSD Health Options (Highmark Health Options), to respond to the State of Delaware's Medicaid Managed Care Organization Request for Proposal, and Highmark Health Options was one of two plans chosen by the State of Delaware in a competitive bidding process. Highmark Health Options is partnering with Gateway Health Plan to support the product and enrolled approximately 75,000 members effective January 1, 2015. Highmark Delaware and Gateway Health Plan will be creating over 100 new jobs in Delaware to support the new Medicaid product.

Highmark Blue Cross Blue Shield West Virginia successfully gained entrance into the Medicaid market by partnering and collaborating with 22 Federally Qualified Health Centers, two primary care clinics and the West Virginia Primary Care Association — forming West Virginia Family Health (WVFH). WVFH is the only provider-sponsored network operating in the state of West Virginia. In the fourth quarter of 2014, VWFH began to deliver services to WV Medicaid members eligible for managed care in 53 of 55 counties in West Virginia. With 44 percent minority ownership, Highmark Blue Cross Blue Shield West Virginia is responsible for managing the overall operations and administration of WVFH.

In February 2014, Highmark entered into a merger agreement with Blue Cross of Northeastern Pennsylvania (BCNEPA) and submitted the agreement to the Pennsylvania Insurance Department (PID) for approval. Assuming approval, BCNEPA, which provides coverage to more than 540,000 individuals, will be merged with and into Highmark, and Highmark will become the Blue Cross and Blue Shield Association affiliate for BCNEPA's current 13-county service area. The proposed merger will help to create greater health care efficiencies and make new products and services available to customers in northeastern and north central Pennsylvania. The PID's decision on the merger is expected to be reached in mid- to late-May 2015.

In December 2014, Highmark subsidiary REMWorks Sleep Store opened its one-of-a-kind retail store in western Pennsylvania, offering a wide range of solutions and products for people suffering from sleeplessness, sleep apnea, snoring and insomnia. The store features trained, licensed sleep coaches who work with each customer to understand why they are having trouble sleeping and to develop a plan to achieve sound sleep.

The health plans are also helping members take charge of their health and make important health care decisions through the newly enhanced Care Cost Estimator web tool. Care Cost Estimator allows members to shop and compare costs on more than 1,600 medical services to enable the members to find lower-cost, convenient, high-quality care. The tool has supplied members with more than 150,000 health care estimates since 2012.

Care Cost Estimator is one of several online transparency health tools designed to help Highmark health plan members make informed decisions about their health care and spending. Online, members also can read patient reviews; compare providers' quality ratings, budget funds by tracking health care finances and follow recommendations for preventive care to stay healthier.

*As of Jan. 30, 2015