MMIT Payer Portrait: CareFirst BlueCross BlueShield

Founded in the 1930s by a Washington, D.C.-based hospital association, CareFirst BlueCross BlueShield is now one of the largest insurers in the Washington metropolitan area, leading the Maryland market and snagging the No. 2 spot in the District itself. It offers commercial health products, including plans sold on the Affordable Care Act exchanges in D.C., Maryland and Virginia, as well as Medicare Advantage (MA) and Medicaid plans. CareFirst is also the second-largest participant in the Federal Employee Health Benefits Program, behind Anthem, Inc., with about 627,000 members.

CVS/caremark currently serves as CareFirst’s pharmacy benefits manager, with CVS Specialty handling specialty pharmacy benefits, and Abarca Health facilitating the Washington, D.C., Medicaid program. As of April 2018, CareFirst began managing its behavioral health services in-house, ending its contract with Magellan Health.

In October 2020, CareFirst finalized its acquisition of the University of Maryland Medical System’s health plan subsidiaries: Trusted Health Plan and Health Partners. Both orgs serve managed Medicaid members in Washington, D.C., and Maryland, respectively, marking CareFirst’s first foray into Medicaid in more than a decade. The deal marked the beginning of a renewed focus on public-sector health care, as CareFirst entered Maryland’s individual MA market in 2021 and the group MA market in 2022. Uptake has been relatively slow, however, as Maryland has a historically low MA penetration rate. CareFirst enrolls just under 10,000 MA lives as of March 2022. Also in 2021, CareFirst partnered with fellow Blues affiliate Highmark Inc. to offer products targeted at labor unions.

SOURCE: AIS’s Directory of Health Plans as of March 2022; MMIT Analytics as of 1Q 2022.

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