Highmark, Capital Blue Cross offer new products for Medicare Advantage shopping period 

Area insurers have rolled out their Medicare Advantage (MA) plans for 2022, boasting a wide range of offerings for a growing base of Medicare beneficiaries seeking new options in the space. 

This month, Capital Blue Cross and Highmark Blue Cross Blue Shield both launched products for the MA shopping period between Oct. 18 and Dec. 7.  

MA plans, also known as Part C coverage, are offered by Medicare-approved private companies and are generally split into Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. 

Member feedback from last year’s cycle showed that Medicare beneficiaries are interested in more flexible over-the-counter benefits as well as all-in-one plans offering supplemental benefits such as flexible debit cards for over-the-counter supplies, said Mike Londre, director of marketing for government programs at Harrisburg-based Capital Blue Cross. 

“We are always listening to our members and the communities we serve to identify ways to enhance and improve our products to best serve them and help improve their health and well-being,” said Londre. “Member service expectations also have increased, and we continue to meet those expectations. Many Medicare beneficiaries prefer a local, community-focused health plan like Capital Blue Cross headquartered near them and with local member services.” 

For Pittsburg-based Highmark, this year’s MA rollout was themed around variety, something that the insurer heard loud and clear from its beneficiaries this year. 

“People wanted more options,” said Ellen Galardy, senior vice president of consumer market strategy and senior products for Highmark. “I wonder if they wanted to feel like they were back in the driver seat after COVID took so much choice from us.” 

Highmark’s 2022 MA products in the Midstate include $0 premium Community Blue Medicare HMO plans with $0 specialist copays, and a $0 premium Community Blue Medicare PPO Signature plan with a $22 Part B premium buy-back. 

The Part B buy-back, first piloted in Lancaster for the past two years, is now being expanded to Dauphin, York and Adams counties. Through the plan, beneficiaries are refunded part of what they pay for the product, which equates to $22 a month. 

“We found two primary audiences for the plan. Someone who explored zero-dollar options in the past and is looking for a plan that balances their monthly income budget,” said Galardy. “The other group are first turning Medicare eligible; your retirees looking to transition into a plan.” 

Highmark has also seen the importance of expanding its plans to services that don’t normally fit as a Medicare plan, such as its “pop-up house” benefit, given to Freedom Blue standard and deluxe plan members. The plan gives beneficiaries a certain number of hours for non-medical care at home. 

Both Highmark and Capital Blue Cross expanded options for beneficiaries with diabetes. Highmark  moved its diabetic testing supplies, such as test strips, to its zero-dollar plans and is now offering Onduo, a diabetes management program to beneficiaries on all plans. Capital Blue Cross’ BlueJourney MA products now include a Part D insulin saver program with monthly supply copays as low as $5. 

Capital Blue Cross’ plans for 2022 include a $0 premium HMO, a $0 premium PPO and a $19 premium PPO. The insurers’ new products for 2022 are expected to enhance quality of care, reduce costs and provide greater access to doctors and hospitals through a new partnership with WellSpan Health. 

Capital Blue Cross announced in September that it would be collaborating with the York-based hospital system to increase access for beneficiaries in Adams, Cumberland, Franklin, Lancaster, Lebanon and York counties. 

“Capital Blue Cross has built a trusted reputation in part by offering our members access to high-quality healthcare they know and feel comfortable with,” said Capital Blue Cross President and CEO Todd Shamash. “We are proud to partner with WellSpan in this unique manner. WellSpan is a natural fit with our member-focused approach to Medicare coverage – providing quality, affordable care coupled with peace of mind and friendly, local service.” 

PA Clinical Network signs value-based contract with Geisinger Health Plan

PA Clinical Network, a Harrisburg-based organization consisting of independent physicians, signed a value-based contract with Geisinger Health Plan. Geisinger is the fifth a regional health insurer to partner with PA Clinical Network and its 150 independent physicians, the two groups announced on Tuesday.

As part of the new partnership, members of Geisinger will see lower costs when going to physicians with the network, whose physicians receive incentives based on the quality of their services.

“The providers of the PA Clinical Network are committed to the continued wellbeing of their patients,” said Dr. Jaan Sidorov, president and CEO of the PA Clinical Network. “Geisinger Health Plan shares our interest in measurable improvements in quality with lower costs and a better member experience supported by a high performing network.”

The Montour County-based Geisinger Health Plan is a provider network of more than 30,000 primary care and specialty physicians, 120 hospitals and 132 urgent and convenient care locations.

“We are pleased to be working with this physician-led network to accelerate the adoption of value-based care across our network,” said Dr. John Bulger, Chief Medical Officer of Geisinger Health Plan.

The health plan joins Aetna, Capital Blue Cross, Highmark Blue Cross Blue Shield and Gateway Health in signing contracts with PA Clinical Network this year.

Capital BlueCross to offer advanced payments to independent health care providers

Capital BlueCross will be offering advanced payments to independent health care providers in their network who have seen at least a 40% loss in payments from a loss in patients due to the COVID-19 pandemic.

The Harrisburg-based insurer announced its new Advance Payment Program on Thursday. The program was designed to help providers keep their doors open until patients return to the office for in-person visits, the company wrote in a press release.

“One of our primary goals as a health insurer is to make sure our members and the communities we serve have access to care, and independent providers are critical to that goal,” said Todd Shamash, president and CEO of Capital BlueCross. “By providing advance payments to help them through this difficult time, we are helping to ensure these providers will be there for our members long after the pandemic has passed.”

As part of the new program, advance payments will be available to eligible providers who lost at least 40% in average payments for services in March and April.

The average payments will be based on the monthly payments providers received from the insurer in 2019 and will be available through July 15.

Capital BlueCross CEO helped reshape the health care company’s role

Gary St. Hilaire, the departing president and CEO of Capital BlueCross, left, and Todd Shamash, the company’s senior vice president, general counsel and corporate secretary, who will serve as acting CEO. PHOTO/ IOANNIS PASHAKIS

Capital BlueCross CEO and President Gary St. Hilaire will leave the Harrisburg-based insurer next month after guiding it through years of growth to become a major presence in the midstate’s competitive insurance market.

St. Hilaire is leaving the company to take a position as president and CEO of Horizon Blue Cross Blue Shield in New Jersey on April 6. Capital’s Board of Directors appointed Todd Shamash to serve as acting CEO. Shamash has been with the company for seven years and is currently senior vice president, general counsel and corporate secretary of Capital BlueCross.

When St. Hilaire joined Capital BlueCross as CFO in 2005, he was entering the company fresh on the heels of five years as CFO for a Manchester, New Hampshire-based health care benefits start-up.

It had been three years since Harrisburg-based Capital Blue Cross and Pittsburg-based Highmark BlueCross BlueShield terminated their agreement to offer joint health insurance in the midstate.

Looking at the stiff competition his new employer had with Highmark, St. Hilaire felt that Capital should be run like a well-funded start-up. For the company to grow, it needed to find its own footing, he said.

“Capital was resetting its position as a fully involved and engaged health plan as opposed to being one part of a health plan, as they were when they were partnered with Highmark,” said St. Hilaire.

Taking a lead

The following years were vitally important for Capital as it worked to differentiate itself in what St. Hilaire referred to as one of the most competitive marketplaces in the country. To stand out from competitors such as Highmark, Aetna and UnitedHealthcare, as well as integrated plans like Geisinger and UPMC, Capital focused on diversifying.

“Capital couldn’t afford to wait, but needed to lead,” said St. Hilaire. “There were things we did because we knew we were in a competitive place and because we wanted to be an innovative leader.”

Capital BlueCross acquired Dominion Dental Services, a privately held dental benefit provider based in Alexandria, Virginia, in 2008 and founded its subsidiary data analytics company, Geneia Technology, in 2011.

In 2010, St. Hilaire became Capital’s president. Two years later, he became CEO.

“We are grateful to Gary for his leadership over the past 15 years,” Capital BlueCross Board Chairman Kathryn Taylor said. “His drive, financial acumen, innovative thinking and commitment to the community have made us a stronger company and cemented our position as the leading health plan in our market.”

On the consumer end of its offerings, Capital placed a stronger emphasis on innovation by being an early adopter of telehealth, and opening Capital Blue Health and Wellness centers in Lehigh and Enola that offer health coaching, personal training and health care coverage consultation.

“Any opportunity we have to engage our members on their health and wellness journey creates a connection and connects them to Capital to understand that the Blue brand means so much more than just benefits you can access,” St. Hilaire said.

Under his leadership, the company focused on building partnerships with health care providers, while some of its competitors looked to decrease costs for their clients through other means, such as ownership.

St. Hilaire also rejected the notion that an insurer could only reduce costs to clients by limiting choices. “If all we are doing is funneling into a more limited, narrow network with the promise that it will be less expensive, then we haven’t done what we should be doing,” he said.

Part of the team

St. Hilaire’s interim replacement, Shamash, has worked throughout the health care industry as a deputy chief of staff for the Pennsylvania Governor’s Office, and senior counsel for Jefferson Health system. He has also been a trustee on the Pennsylvania Employee Benefits Trust Fund, a commissioner of the Pennsylvania Banking and Securities Commission and department counsel for the Pennsylvania Insurance Department.

St. Hilaire called Shamash a key member of Capital’s team, bringing to the table years of experience in both the provider and regulatory sides of health care.

“The last seven years have been exciting, wonderful and certainly challenging with the market (we are operating in),” said Shamash. “It took learning how to move very quickly on innovation but also making sure that we are competitive with publically traded insurance companies and companies that own hospitals as well as insurance companies.”

Shamash grew up in the region and said that returning to the area to raise his family and be a part of a company like Capital was important to him.  Capital was appealing to Shamash from the start because of the resources it has as a multi-billion dollar company. And its focus on the Lehigh and central Pennsylvania regions keep it nimbler than its competitors in other states.

Under St. Hilaire’s leadership, Capital built a strong management team that will be able to continue as a market leader and maintain a member-centric strategy, according to Shamash.

“I was excited when I was approached by Gary and the board to have this opportunity because I know that we have to keep moving and we can’t miss a beat to be successful for our members and our employees,” he said.

St. Hilaire leaving Capital BlueCross this April

Gary St. Hilaire, Capital BlueCross president and CEO, will be leaving the company to lead a neighboring BlueCross Blue Shield insurer this April. Todd Shamash, the company’s senior vice president, general counsel and corporate secretary will be taking over the position in St. Hilaire’s absence. PHOTO SUBMITTED

Gary St. Hilaire, Capital BlueCross president and CEO, will be leaving the company to lead a neighboring BlueCross Blue Shield insurer this April.

St. Hilaire first joined the Harrisburg-based Capital BlueCross in 2005 and has led as its president and CEO since 2012. The company said Tuesday that he will be leaving to take up the mantle of president and CEO of Horizon Blue Cross Blue Shield in New Jersey on April 6.

“We are grateful to Gary for his leadership over the past 15 years,” said Kathryn Taylor, Capital BlueCross Board Chairman. “His drive, financial acumen, innovative thinking and commitment to the community have made us a stronger company and cemented our position as the leading health plan in our market.”

In St. Hilaire’s place, Capital BlueCross’ Board of Directors has appointed Todd Shamash to acting CEO, effective April 6. Shamash has been with the company for seven years and is currently senior vice president, general counsel and corporate secretary of Capital BlueCross.

During his time at Capital BlueCross, Shamash has been an integral part of the company’s strategic partnerships, diversification strategy and subsidiaries.

“Known throughout the organization for his thoughtful approach and unflappable demeanor, Todd brings both a deep knowledge of the company and its current initiatives, as well as a keen understanding of the industry through his past experience,” said Taylor. “Todd and our exceptional management team will continue to build on Capital BlueCross’ successes as an independent, community-focused health plan and foster the further growth of our subsidiaries in Central Pennsylvania, the Lehigh Valley and beyond.”

Shamash serves as an appointee of Gov. Tom Wolf on the state’s Health Care Cost Containment Council and is an appointee of the Pennsylvania Senate President Pro Tempore on the Pennsylvania Health Insurance Exchange Authority. He was previously the deputy chief of staff for the Pennsylvania Governor’s Office and senior counsel for Jefferson Health System in Philadelphia.

New Capital BlueCross and Highmark partnership with Civica Rx could provide cheaper generic meds to members

Highmark Health and Capital BlueCross, along with 16 other Blue Cross Blue Shield organizations across the country, announced they will be  founding members of a new nonprofit generic drug manufacturer.

The members of both insurance companies could have access to cheaper generic prescription drugs by as early as 2022, following a recent deal the insurance organizations made with Lehi, Utah-based Civica Rx.

Civica Rx is a nonprofit generic drug manufacturer formed in 2018 by three national philanthropies and over 1,200 hospitals in 46 states. The nonprofit manufactures its generics for the hospitals it partners with at predictable volumes and with lower pricing compared to its non-generic counterparts.

In the partnership with the Blue Cross Blue Shield organizations, Civica and the organizations formed a subsidiary that will provide a similar service, but in an outpatient setting.

“Over the past few years, overall drug prices have continued to rise. Generic drugs, which have historically offered a more cost-effective option for consumers, have also been impacted by these market dynamics,” said Sarah Marchè, senior vice president of pharmacy services for Highmark. “Decreased market competition in generic drug manufacturing has placed a greater financial burden on our health care system and created a barrier to better health for our members.”

Along with Capital BlueCross and Highmark, Philadelphia-based Independence Blue Cross is also a partner on the deal.

The 18 Blue Cross Blue Shield companies provided $55 million towards the new subsidiary, which will begin selecting generic drugs to produce based on which generics have uncompetitive markets and what products would have the highest potential for savings.

The first generics to be produced by the subsidiary are expected to be available in early 2022.

“Everyone should have access to quality healthcare and affordable prescription drugs, no matter who they are or where they live, and this new partnership is one way to ensure the needs of the individual come first and that the savings are passed along to them,” said Gary St. Hilaire, CEO and president of Capital BlueCross.

Correction: The story was changed to include Capital BlueCross and Independence Blue Cross as partners in the deal with Civica Rx.