With all the major pullouts from the Medicare risk marketplace in recent weeks, the actions of a number of Blues plans were almost lost.
Six Blue Cross and Blue Shield plans, including five not-for-profits, joined other health plans in yanking coverage from selected markets. The moves, which left 34,000 seniors scrambling to find new coverage, appeared to contradict the Blues' historic role as social welfare organizations, a charge hotly denied by the national Blue Cross and Blue Shield Association.
But critics say the Blues plans increasingly are adopting the business practices of their for-profit counterparts in the managed-care industry.
"The not-for-profits often mimic the for-profit organizations in terms of their market practices and feel they need to do so in order to survive," said Ron Pollack, executive director of Families USA, a national consumer advocacy group based in Washington.
"I'm not sure there are huge differences" between the strategies of for-profits and not-for-profits, he said.
"This really doesn't have to do with the social mission of the Blues plans," said Bill Pierce, a spokesman for the Chicago-based Blue Cross and Blue Shield Association. "The rules of economics still apply."
Pierce said the recent exodus of Blues plans (July 5, p. 3)-part of managed care's much broader pullback from Medicare risk contracting-has more to do with the changing economics of Medicare than with a changing focus for Blues plans.
Most of the Blues enrollees affected by the pullouts are covered by Blue Cross and Blue Shield of Arizona, which is dropping all Medicare HMO coverage in the state; Owings Mills, Md.-based CareFirst Blue Cross and Blue Shield, which is exiting 17 counties in rural Maryland; and Colorado Blue Cross and Blue Shield, which is departing Boulder and Pueblo counties.
In addition, roughly 4,700 enrollees covered by Trigon Healthcare and Blues plans in Texas and South Carolina will be affected by pullouts announced before the July 1 deadline.
Pullouts by the Blues and other plans nationwide take effect Jan. 1, 2000.
Of course, some Blues plans don't just act like for-profits; they are for-profits. The Georgia Blues, Trigon, and WellPoint Health Networks, Thousand Oaks, Calif. (which plans to acquire the Georgia Blues), have already converted to for-profit status, and several other Blues plans are considering the step.
Thomas Snead, president and chief executive officer of Richmond, Va.-based Trigon, said inadequate government funding for Medicare+Choice plans in some markets, including rural areas, "left us no other choice" but to pull out of those markets.
Close to 1 million enrollees nationally continue to be covered by Blues-run Medicare risk plans, said Pierce, "so the (pullout) numbers are not that significant."
Surveying the damage from the recent wave of Medicare risk pullouts by managed-care plans, HCFA said last week that things don't look that bad. Market exits or benefit reductions by "a small but significant number of health plans" will affect about 327,000 enrollees, or 5% of all Medicare managed-care enrollees, by year-end, and 79,000 will have to return to fee-for-service Medicare, HCFA Deputy Administrator Michael Hash said in a written statement.
Nonetheless, so far this year, HCFA has approved nearly 40 plans to enter the Medicare risk program or expand their service areas, and nearly 200,000 new enrollees have joined Medicare+Choice since Jan. 1, he said.
Last year about 450,000 Medicare managed-care enrollees were forced to find new coverage; 50,000 of them had to return to Medicare's fee-for-service program.
Among non-Blues plans, Aetna U.S. Healthcare, Foundation Health Systems, Humana, Oxford Health Plans, PacifiCare Health Systems and United Healthcare Corp. announced plans to drop some Medicare risk markets late last month, just in time to meet HCFA's notification deadline.