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Blue Shield of California

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Blue Shield of California
Company typeNon-profit health plan (tax exempt status removed in 2014)[1][2]
IndustryHealthcare
Founded1938 (created)[3]
1939 (incorporated)[3]
FounderCalifornia Medical Association[3]
Headquarters601 12th Street
Oakland, California
Key people
Paul Markovich,
President and chief executive
RevenueIncrease $21.8 billion USD (2020)[4]
Increase $680 million USD (2020)[4]
MembersIncrease 4.5 million (2021)[5]
Number of employees
7,500 (2021)[5]
Websiteblueshieldca.com

Blue Shield of California is a mutual benefit corporation and health plan[6][7] founded in 1939 by the California Medical Association. It is based in Oakland, California, and serves 4.5 million health plan members and more than 65,000 physicians across the state. Blue Shield of California was founded as a not-for-profit organization. As of 2014, it is no longer tax-exempt in California and has been paying federal taxes for several years before that.[2]

History

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Blue Shield of California, then known as California Physicians' Service, was created by the California Medical Association in 1938. The organization was incorporated in 1939 and began offering coverage on March 6 of that same year. In 1946, the organization was among the founders of the National Association of Blue Shield Plans, which later became the Blue Cross and Blue Shield Association.[8] In 1950, the Blue Shield of California health plan began offering catastrophic coverage.[8][9] By 1961, it had one million subscribers of its health plan.[8] From 1966 to 2018, the organization was headquartered at 50 Beale Street in San Francisco.[10]

In 1984, it began covering heart transplantations offered at Stanford University Medical Center.[11]

The Blue Cross of California, which traditionally covered the hospital portion of insurance as a separate entity, went public in 1992 under the name Wellpoint, with the name later changing to Anthem.[12] Blue Shield began offering information on benefits and enrollment on the Internet in 1996, and offering an online enrollment system for agents in 1998.[8] In 1997, Blue Shield acquired the managed care company CareAmerica.[13]

In 2006, Blue Shield agreed to a $6.5 million settlement relating to allegedly modifying the risk tier structure of its individual and family health care plans. In 2008, the organization settled for $3 million with the California Department of Managed Health Care to resolve allegations of improper rescission of individual health plan coverage. Further, the organization reinstated coverage to 450 members whose plans had been canceled and agreed to provide compensation for any medical debts incurred by these policyholders due to the rescission.[14]

In 2010, Blue Shield of California, Dignity Health, and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in the California Public Employees Retirement System (CalPERS). During its first 2 years, this program reduced inpatient use and health care costs significantly.[15]

In 2015, Blue Shield entered the Medicaid market by acquiring Care1st Health Plan.[16] Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.[17]

In 2019, Blue Shield of California launched the healthcare company Altais. In 2020, Altais acquired the San Francisco practice Brown & Tolland.[18]

Network

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Blue Shield of California's provider network currently includes 65,000 physicians[19] and more than 340 hospitals statewide.[20]

In the California Healthcare Quality Report Card 2009 Edition, Blue Shield of California received 3 out of 4 stars in Meeting National Standards of Care and 2 out of 4 stars in How Members Rate Their HMO.[21]

Financial

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In 2011, Blue Shield announced that it would cap its net income at no more than 2% of revenue, contingent on approval from the board of directors.[22] As of 2019, more than $600 million has been returned to customers and the community as a result of the pledge.[23]

In 2014, Blue Shield of California lost its exemption from California state corporate income tax. This information became public in March 2015.[24] A claimed recent application of the duck test resulted in the denial of Blue Shield's tax-exempt status.[25] This was after "a lengthy state audit that looked at the justification for Blue Shield's taxpayer subsidy." Blue Shield holds billions in cash reserves and spends millions in executive pay. The organization defended its tax-exempt status, but failed to provide sufficient evidence to California Franchise Tax Board that its actions align with such obligations.[24] As a result, Blue Shield became a tax-paying nonprofit.[6]

In 2020, Blue Shield of California reported $21.8 billion in revenue and $680 million in net income.[4]

References

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  1. ^ "Mission and Values – Blue Shield of California". blueshieldca.com. Retrieved March 17, 2016.
  2. ^ a b "With billions in the bank, Blue Shield of California loses its state tax-exempt status". Los Angeles Times. March 18, 2015. Retrieved September 1, 2016.
  3. ^ a b c "Corporate History and Timeline – Blue Shield of California". blueshieldca.com. Retrieved March 17, 2016.
  4. ^ a b c "Blue Shield of California Consolidated Financials" (PDF). Blue Shield of California. 2020. Retrieved May 7, 2021.
  5. ^ a b "Fact sheet" (PDF). Blue Shield of California. 2021. Archived (PDF) from the original on May 12, 2021.
  6. ^ a b Young, Samantha; Hart, Angela (March 22, 2021). "Newsom Awarded the No-Bid Vaccine Contract to Blue Shield, a Trusted and Generous Supporter". KQED. Archived from the original on March 23, 2021. Retrieved May 7, 2021.
  7. ^ Terhune, Chad (June 6, 2015). "Blue Shield faces more heat over nonprofit status, $1.2-billion deal". Los Angeles Times. Archived from the original on June 6, 2015. Retrieved May 7, 2021.
  8. ^ a b c d "Corporate History and Timeline". Blue Shield of California. September 12, 2011. Archived from the original on March 22, 2006. Retrieved May 3, 2021.
  9. ^ Dickinson, Frank G. (1964). Medical Care in Transition. Vol. 1. Reprints from the American Journal of Public Health. U.S. Department of Health, Education, and Welfare, Public Health Service. p. 103. OCLC 1012029666.
  10. ^ Li, Roland (March 8, 2017). "Blue Shield to move headquarters from San Francisco to Oakland with massive lease". American City Business Journals.
  11. ^ Evans, Roger W. (January 1987). "The economics of heart transplantation". Circulation. 75 (1): 73. doi:10.1161/01.CIR.75.1.63. PMID 3098447.
  12. ^ "Don't call us WellPoint, says newly named Anthem". Indianapolis Star. Retrieved May 24, 2019.
  13. ^ "Blue Shield of California: Acquires Careamerica".
  14. ^ "2 health insurers to pay $13M to Calif. regulators". AP/Google. July 18, 2008. Archived from the original on July 21, 2008. Retrieved July 18, 2008.
  15. ^ "Accountable Care Organization Featuring Shared Global Risk Stimulates Development of Initiatives To Improve Care, Reduces Inpatient Use and Costs". Agency for Healthcare Research and Quality. May 8, 2013. Retrieved May 9, 2013.
  16. ^ "Blue Shield of California Closes on Acquisition of Care1st, Enters Medi-Cal/Medicaid". Blue Shield.
  17. ^ "Care1st Health Plan Changing Its Name". L.A. Care Health Plan. December 13, 2018. Retrieved June 21, 2019.
  18. ^ "In Northern California, Two Organizations Partner to Support Independent MD Practices Around Value". November 25, 2020.
  19. ^ Pena, Luz (March 3, 2021). "Blue Shield CEO explains plan to increase CA's vaccine doses to 4M per week". ABC7 San Francisco. Archived from the original on March 3, 2021. Retrieved April 30, 2021.
  20. ^ "Fact Sheet" (PDF). Blue Shield of California – News Center. June 2018. Archived (PDF) from the original on October 6, 2019. Retrieved April 30, 2021.
  21. ^ State of California – Health Care Quality Report Card 2009 Edition Archived July 19, 2011, at the Wayback Machine
  22. ^ Brown, Steven E.F. (June 7, 2011). "Blue Shield of California to limit profit to 2% of revenue". San Francisco Business Times. Archived from the original on June 10, 2011. Retrieved May 7, 2021.
  23. ^ "Financials". Blue Shield of California. 2020. Archived from the original on April 18, 2020. Retrieved May 7, 2021.
  24. ^ a b Terhune, Chad (March 18, 2015). "With billions in the bank, Blue Shield of California loses its state tax-exempt status". Los Angeles Times. Archived from the original on March 18, 2015. Retrieved May 7, 2021.
  25. ^ Seipel, Tracy (March 19, 2015). "California drops hammer on Blue Shield tax-exempt status". San Jose Mercury News. Retrieved March 19, 2015.
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