MMIT Payer Portrait: GuideWell Mutual Holding Corp.

Founded in 1944 as the Florida Hospital Service Corp., GuideWell Mutual Holding Corp. is one of the largest Blue Cross and Blue Shield affiliates in the U.S. GuideWell is the parent company of Florida Blue, Capital Health Plan, Inc., Florida Health Care Plan, Inc. and, as of Feb. 1, Triple-S Management Corp. With more than 3.7 million members enrolled in its commercial and Medicare Advantage products, Florida Blue is the largest insurer in Florida.

GuideWell is a partial owner of its primary pharmacy benefits manager, Prime Therapeutics LLC, the PBM owned and operated by 19 Blues affiliates. AllianceRx Walgreens Prime, the PBM’s specialty pharmacy partnership with Walgreen Co., handles much of its specialty contracting, though the company also works with Accredo Health Group, Inc. and CVS Specialty. GuideWell subsidiary Florida Health Care Plan, Inc. contracts with OptumRx for PBM services.

In February 2022, GuideWell finalized its $900 million acquisition of Triple-S, the largest insurer in Puerto Rico, covering about 35% of the U.S. territory’s medical lives. It is also the Blues affiliate for the island. With this deal, GuideWell cracked the top 10 Medicare Advantage insurers by enrollment for the first time, according to AIS Health’s February 2022 public sector update. The deal also marks GuideWell’s first major foray into Medicaid, as Triple-S covers 36.0% of Puerto Rico’s 1.3 million managed Medicaid members.

In a notable feat for a regionally focused insurer, GuideWell is the second-largest provider of individual commercial products in the U.S., behind only Centene Corp. Though Centene takes the lead on the national level, GuideWell beats out the market leader in its home state, holding 53.6% of Florida’s individual market share. The majority of those members are enrolled in Affordable Care Act exchange plans, which have seen a boom in enrollment amid the COVID-19 pandemic. Unlike large national insurers, which scaled back their exchange presences significantly in 2016 and 2017 as the markets destabilized (Cigna Corp., UnitedHealthcare and CVS Health Corp.’s Aetna left the Florida market entirely), Florida Blue continued to offer exchange products in every county in the state, leveraging narrow networks and individualized care management strategies to keep costs low. Partially due to Florida Blue’s efforts, Florida alone accounts for 18.1% of all exchange lives in the country, making the market attractive to newer entrants such as Oscar Health, Bright Health and 2020 re-entrant Cigna.

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

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