BCBS members were sicker and more expensive following ACA expansion

Blue Cross Blue Shield health plans saw higher rates of chronic illness and access to medical care among members after provisions of the Affordable Care Act expanded coverage to more Americans, according to a report released by the BCBS Association.  

Based on a review of claims data before and after 2014--when healthcare reforms broadened access to health insurance to high risk individuals--Blues plans saw a spike in several chronic conditions including hypertension, diabetes, depression, coronary artery disease and HIV, accompanied by higher healthcare costs.

For example, prior to 2014, rates of individuals with diabetes enrolled in BCBS plans stood at 235 per 10,000. After new ACA provisions took effect, that rate jumped to 456 per 10,000 among newly enrolled individuals.

BCBS also saw significant spikes in new members with hepatitis C and HIV. After 2014, new enrollees with hepatitis C increased 140 percent, while members with HIV shot up 242 percent. Newly enrolled members also required more medical care with higher rates of inpatient hospital admissions, outpatient visits, medical professional services and prescriptions throughout the first three quarters of 2015.  

The insurer experienced higher costs as a result. From the beginning of 2014 through the third quarter of 2015, average monthly spending per member increased from $436 to $569.

In a release, the BCBS Association highlighted its focus on patient-focused care programs in an effort to reduce expensive hospital admissions and control chronic conditions through prevention and wellness initiatives.

"The findings underscore the need for all of us in the healthcare system, and newly insured consumers, to work together to make sure that people get the right healthcare service in the right care setting and at the right time," Alissa Fox, senior vice president of the office of policy and representation for the association, said in the release.

"Better communication and coordination is needed so that everyone understands how to avoid unnecessary emergency room visits, make full use of primary care and preventive services and learn how to properly adhere to their medications."

Previous reports have shown healthcare plans have struggled because an influx of sicker patients flooded the ACA marketplace. Throughout the first three quarters of 2015, BCBS plans paid out more in medical costs than they received in premiums, leading to an expected decline in overall earnings.

To learn more:
- here's the BCBSA report
- see the BCBSA release

Related Articles:
Q4 earnings roundup: Big five insurers' ACA exchange woes deepen
Medical costs for BCBS individual plans outpaced premiums in 2015
Fitch expects BCBS companies' 2015 earnings to fall
Blue Cross Blue Shield Association expands value-based network to national employers

Suggested Articles

Blue Cross and Blue Shield of North Carolina and Cambia Health Solutions have jointly decided to end their talks to enter a "strategic affiliation."

The Trump administration's new rules to overhaul the Stark Law have some areas that could create major regulatory headaches.

Medicare Part D beneficiaries could see their out-of-pocket costs go up next year before they reach catastrophic coverage, a new analysis shows.