2015 Annual Report

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2015 Annual Report

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2015 Annual Report

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CEO Letter
ANDREW
DREYFUS

Over the past year, Blue Cross has taken a fresh look at what our longstanding promise to always put our members first means in this age of active consumerism – starting from the member’s perspective.
Read the full Letter

Y Our
Stories

More 2015 Highlights

Membership Growth and Positive Net Income

Our membership grew for the third straight year in a highly competitive marketplace, and the company finished 2015 with positive net income, despite increased taxes and fees to support health care reform and the high cost of some new "specialty drugs" used to treat complex chronic conditions.

Expansion of Quality-Based Incentives

We refined and expanded the highly successful contract model by which we reward physicians and hospitals when they improve quality of care for our members while lowering costs. We now include both HMO and PPO members in quality-based payment contracts, and we have added new health-outcome performance measures that are based on clinical data and patient feedback.

Opioid Risk Reduction, Treatment, and Recovery

Our Prescription Pain Medication Safety Program, created in 2012 with the help of an outside panel of physicians, pain management experts, and addiction specialists, has reduced the risk of addiction and other potential health issues related to long-term use of opioid-based painkillers. In three years, the program reduced opioid-based medication prescriptions by an estimated 21.5 million doses. At the same time, we have enhanced treatment programs that aid and sustain recovery from opiate use disorders.

Leadership in Advanced Illness Care and Benefits

We collaborated with physicians, researchers, and an organization headed by Dr. Atul Gawande to develop a program aimed at improving quality-of-life for individuals and families facing advanced illnesses and the end of life. Launched in 2016, Complete Care for Advanced Illness is designed to enhance patient-clinician communication and support high-quality, compassionate care that honors people’s values and priorities.

Targeted Investment in Health Care Innovation

Zaffre Investments, which we created two years ago, continues to help fund innovations aimed at improving the delivery and use of health care. Their recent investments include: technology that gives providers remote access to their patients’ imaging records at any time; a personal application that helps consumers understand their health benefits and manage their costs; and mobile devices that allow respiratory patients and their doctors to measure lung function and track medication use.

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2015Year in Review

3.6K Associates
Employed
2,035,983 Massachusetts Members
808K Out-of-state
Members
29.5K Employer
Accounts
2.76M Answered calls
46M PROCESSED CLAIMS
$13.7B PAIDTOWARD MEMBER CARE
$300M PAIDIN TAXES & ASSESSMENTS

CORPORATE CITIZENSHIP

COMMUNITY INVESTMENTS

$6.0M

CONTRIBUTED
to

497

NONPROFITS

CIVIC ENGAGEMENT

$1.4M+

VALUE OF
SERVICE

89%

OF ASSOCIATES
VOLUNTEERED

230+

COMMUNITY
PROJECTS

350+

ASSOCIATE
PROJECT LEADERS

350+

ASSOCIATE
PROJECT LEADERS

SUSTAINABILITY

14%

GREENHOUSE GAS
REDUCTIONS

16%

LESS WASTE TO
LANDFILL

36%

LESS PAPER USE

Five year results, 2010 - 2015

FOUNDATION

$3.8M IN GRANTS
to
77 COMMUNITY
ORGANIZATIONS

DIVERSITY & INCLUSION

900

associates participated in an Employee Resource Group

Up 49% from 2014

888

of our associates are people of color — a quarter of our workforce

38% of new hires in 2015

2,500+

of our associates are women, comprising 71% of all associates

60%

of our manager and leadership roles are held by women

934

of our associates are Millennials

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AWARDS & RECOGNITION

Our Medicare Advantage PPO and HMO plans are among the highest-rated in the U.S.1
Our commercial PPO and HMO plans are among the highest-rated in the U.S.2
A Top Rating for Our Medicare Advantage Plan3
A Top Rating for Our Blue MedicareRx plans3

American Heart Association

Fit Friendly Worksite Gold Achievement

Room to Grow

Early Childhood Corporate Champion Award

Raising A Reader Massachusetts

Leadership in Literacy Award

People Making a Difference

Award for Exemplary Community Partnership

Boston Globe

Top Places to Work in Massachusetts

Human Rights Campaign

Top Places to Work for LGBT Employees

Boston Business Journal

Healthiest Employers in Massachusetts

1 National Committee for Quality Assurance (NCQA) Medicare Health Insurance Plan Ratings 2015-2016. Blue Cross Blue Shield of Massachusetts' Medicare Advantage PPO Plan and Medicare Advantage HMO Plan are rated 4.5 out of 5 overall nationally. NCQA is not affiliated with Blue Cross Blue Shield of Massachusetts or CMS, nor is the award given or endorsed by Medicare.

2 National Committee for Quality Assurance (NCQA) Private Health Insurance Plan Ratings 2015–2016.

3 U.S. News used data from the Centers for Medicare & Medicaid Services (CMS), including its rating of each Medicare Advantage and Medicare Part D plan. For an insurer to make the U.S. News list, its plans available in a given state had to earn an average rating of at least 4.5 out of 5 stars, and all its plans in the state had to earn at least 3 stars. U.S. News is not affiliated with CMS, nor is the award given by Medicare.

FINANCES

Per Dollar Spent

90¢ Medical Care For Our Members
45¢ Hospital Services
30¢ Physician services
15¢ Prescription Drugs
10¢
Administrative Costs
  • Pay and Benefits
  • Facilities Maintenance
  • Contributions to Reserves
  • IT Investments
  • Taxes and Assessments

2015 Audited Financial Reports

2015 Audited Financial Reports include Audited Statutory-Basis Financial Statements for Blue Cross and Blue Shield of Massachusetts, Inc. for the years ended December 31, 2015 and 2014 with Report of Independent Registered Public Accounting Firm.

The reports also include the Audited Statutory-Basis Financial Statements for Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. for the years ended December 31, 2015 and 2014 with Report of Independent Registered Public Accounting Firm.

2015 Blue Cross and Blue Shield of Massachusetts HMO Blue, Inc. 2015 Blue Cross and Blue Shield of Massachusetts, Inc.

2015 Combined Balance Sheets and Income Statements

Our Combined Balance Sheets and Income Statements provide a statutory-basis overview of the financial results of both Blue Cross Blue Shield of Massachusetts, Inc. and Blue Cross Blue Shield of Massachusetts HMO Blue, Inc.

2015 Combined Balance Sheets and Income Statements

Y Our
Leadership

  • Bruce Bullen

    Chief Operating Officer

  • Deborah Devaux

    Senior Vice President, Consumer and Provider Solutions

  • Andrew Dreyfus

    President and Chief Executive Officer

  • John A. Fallon

    Chief Physician Executive

  • Patrick Gilligan

    Executive Vice President, Sales, Marketing & Product

  • Stephanie Lovell

    Executive Vice President, Medicare and Chief Legal Officer

  • Jay McQuaide

    Senior Vice President, Corporate Communications and Citizenship

  • Susan L. Sgroi

    Senior Vice President, Organizational Effectiveness and Chief Human Resources Officer

  • Allen P. Maltz

    Executive Vice President, Chief Financial Officer

  • Jason Robart

    President and CEO, Zaffre Investments, Chief Strategy Officer

as of December 31, 2015

  • George R. Alcott, III

    Vice President, Massachusetts AFL-CIO

  • Brian M. Barefoot

    President Emeritus, Babson College

  • Francis X. Callahan, Jr.

    President, Massachusetts Building Trades Council

  • Andrew Dreyfus

    President & CEO, Blue Cross Blue Shield of Massachusetts, Inc.

  • Helen G. Drinan Vice Chair

    President, Simmons College

  • Richard C. Garrison

    President, Bink Inc.

  • Philip W. Johnston

    President, Philip W. Johnston Associates

  • Ralph C. Martin, II

    Senior Vice President & General Counsel, Northeastern University

  • Robert F. Meenan, MD

    Dean, Boston University School of Public Health

  • Paula A. Price

    Senior Lecturer, Harvard Business School

  • Dorothy E. Puhy

    Executive Vice President & COO, Dana-Farber Cancer Institute

  • Donald K. Stern

    Managing Director, Affiliated Monitors

  • Timothy M. Sweeney

    President, Liberty Mutual Personal Insurance

  • Benaree P. Wiley

    Principal, The Wiley Group

  • Phyllis R. Yale Chair

    Senior Advisor, Bain & Company, Inc.

as of December 31, 2015