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CareFirst considers offering Medicare and Medicaid products

CareFirst President and CEO Brian Pieninck

CareFirst President and CEO Brian Pieninck

CareFirst BlueCross BlueShield may make a play to enter the Medicare Advantage and managed Medicaid markets, Brian Pieninck, the insurer’s president and CEO, said.

Pieninck took over as CareFirst’s president and CEO over the summer.

CareFirst has not been in the Medicare Advantage market in nearly two decades, but Pieninck sees the market as an opportunity to continue to carry out CareFirst’s mission.

“This organization as a not-for-profit mission-driven company, I think, has a responsibility to best serve the needs of Medicaid and Medicare,” he said. “I think that part of that is a public policy position. But I think a part of that is services, offering services — managed Medicaid, Medicare Advantage — to provide another alternative and, frankly what we think is considered the best-in-class option in the commercial market, to have the same best-in-class option for state and federal programs.”

On the Medicare side, CareFirst currently only offers supplemental Medicare. But getting into the Medicare Advantage market could help provide a continuity of care, potentially from cradle-to-grave, for CareFirst’s Maryland customers.

Currently, patients and members reaching retirement age do not have a lot of Medicare choices from CareFirst. That could lead to disruption, especially for people who may have been with a specific provider for a long time.

“(Members) potentially need to change the way they interact with their health plan, they need to potentially select a new provider,” Pieninck said. “It introduces an amount of disruption at a time that I think is probably one of the least desirable times that someone could be faced with those kinds of choices.”

On the Medicaid side, a move to introduce a Medicaid product and especially a managed care product, would fit with the CareFirst mission, Pieninck said.

As part of that mission, the insurer has supported Medicaid and especially Medicaid expansion under the Affordable Care Act. But the insurer does not currently offer any Medicaid products.

“I believe it’s the right thing to do as a not-for-profit,” Pieninck said. “We believe that in order for Medicaid expansion to be most meaningful, the greatest number of thoughtful choices mostly in community health have to participate, and we count ourselves among that group.”

But moving to get involved in the Medicare and Medicaid markets would take some time and some work. At the earliest, CareFirst sees entering one of these markets in 2021.

Part of the work involved would be getting buy-in from communities, part of what Pieninck sees as a CareFirst focus on responding to community needs as a way to bring down health care costs.

“It doesn’t serve anybody’s interest if we get into the space and we are not prepared to manage the very unique demands of these two very different programs,” he said. “We will spend a fair amount of time pulling that apart and ensuring that our entry is thoughtful. We want to validate that the community at-large has an interest in us participating in this market.”

But CareFirst’s entry into these markets would also introduce stiff competition for those already providing coverage in the markets. A lot of those providers include health systems.

“Would there be those that prefer we not enter the space competitively? It’s possible,” he said. “Does that interest trump the interest of the local community or of the providers in the community? I don’t think it does.”

Since taking over as CareFirst’s president and CEO, Pieninck has met with a number of health system presidents. And he believes some of those who also run managed care options would welcome CareFirst’s entry to the market.

“I think that the provider community that has built managed care options for both Medicaid and Medicare, that there are those within that community that actually welcome BlueCross BlueShield as a stable option in the community, as long as our participation comes with a commitment to continue to collaborate with providers,” he said. “I think the two things go hand-in-hand.”

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