At Blue Cross Blue Shield of Michigan, we put our members and their employers first. As a nonprofit mutual insurer, our purpose is to pay for care and make health care more affordable, accessible and effective. Unlike investor-owned, for-profit insurers, we do not use member premiums to pay shareholders. Rather than maximize profit, our objective is to be a responsible steward of our members’ financial investment in health care and to enable healthier communities through local efforts to promote health.
We know health care is too expensive, and we need to do more. That’s why we act as stewards of our members’ health and health care dollars, focusing on lowering costs, improving access and delivering value.
Lowering Costs
Unlike for-profit insurers that prioritize profits and shareholder returns, we prioritize our members’ health. At Blue Cross, this means:
▪ Operating on Low Margins: Over the past 10 years, we have averaged an operating margin of less than 1%, demonstrating our commitment to putting our members and the affordability of health care ahead of profit. In 2024, our operating margin was – 4.2%.
▪ Value-Based Care: We are constantly working to make health care better. Our Blueprint for Affordability and Value Partnerships initiatives are changing how health care services are paid for – rewarding providers for achieving better patient outcomes. This has helped avoid $6.3 billion in unnecessary medical expenses that didn’t end up in the premiums our members pay for health insurance.
▪ Generic Drugs and Biosimilars: Because of the monopoly that drugmakers have on new drugs, we innovate to bring competition to market to lower our members’ costs. We have enabled the use of lower-cost alternatives for high-price prescription drugs with biosimilars, leading to substantial cost-savings.
▪ Price Edge Pharmacy Savings: Price Edge automatically finds the lowest price available on medications when our members fill their generic prescriptions. Through Price Edge, Blue Cross and Blue Care Network members saved $41.6 million in 2024.
Making Health Care More Accessible
Affordable health care isn’t just about costs — it’s about ensuring our members get the right care, at the right time, in the right setting.
▪ No-Cost Preventive Care: Our health plans cover 100% of the cost for preventive screenings, annual checkups, vaccines, and cancer screenings to help our members stay healthy.
▪ 24/7 Telehealth & Online Visits: We provide members with virtual primary care and behavioral health services, so they have access to doctors and therapists anytime, anywhere.
▪ Blue Cross Collaborative Care: We are working with leading primary care doctors to make mental health care services and support available in the primary care setting thus avoiding multiple provider visits.
▪ Homeward Rural Health Partnership: We are expanding home-based and virtual care to 65,000 eligible Medicare Advantage members in underserved areas.
▪ Maven Women’s Health Support: We offer maternity, postpartum and menopause care at no additional cost, providing 24/7 expert access.
Innovating to Improve Member Health
We don’t just react to industry challenges — we lead the way in creating solutions that work better and cost less.
▪ Predictive Analytics for Early Detection: We use AI-driven insights to identify members who are at risk for chronic kidney disease and hospital readmissions – and then work with them before their conditions worsen.
▪ Blue Cross Coordinated Care (BCCC): Our staff of highly-trained nurses help our members navigate complex health care needs, ensuring timely appointments and better health outcomes.
▪ Evio Pharmacy Solutions: We joined with four other Blue Cross and Blue Shield-licensed health plans to launch this company, which is using real-world data to evaluate the effectiveness of high-cost drugs and ensure our members get the most value out of their prescription drugs.
▪ Mobile Member App & Digital ID Card: Our award-winning app provides our members instant access to their claims, coverage details and personalized health recommendations to simplify care. It also includes a digital member ID card that members can use at the doctor’s office and pharmacy.
We’re Different
Investor-owned, for-profit insurers operate to maximize shareholder profits. We operate to maximize member value.
▪ Reinvesting in Member Health: In 2024, we paid $100 million per day for our members’ care and benefits.
▪ Paying for Care: We try to manage our margins to slightly above 1%. But in 2024, our margin was — 4.2%. We paid $1.04 for our members’ care for every $1 collected in premiums – absorbing costs that were rising faster than member premiums.
▪ Largest Value-Based Care Network in Michigan: We have contracted with 20,000-plus physicians and 100-plus hospitals to focus payment on transforming how health care is delivered and producing high quality outcomes, not just the quantity of services performed.
▪ Partnering with Civica Rx: We partnered with a nonprofit drug manufacturer to create affordable generic medications, increasing access to lower-cost treatments.
▪ EnablingYesRx: Blue Cross, in partnership with other Michigan health systems, has enabled the development of YesRx – an organization that improves cancer medication access for vulnerable cancer patients lacking financial means to pay for cancer medications. YesRx increases access to free cancer medications and prevents waste. More than $14 million in medication has been provided at no cost to Michigan patients.
▪ Simplifying Prior Authorizations: We are working to speed up prior authorization of essential treatments and specialty care while developing authorization programs that focus on efficiencies that allow providers to spend more time with patients and less on paperwork.
▪ Preventing Unnecessary ER Visits: Through value-based care and primary care access, we’ve helped reduce avoidable emergency room trips by 23%.
We Need to Do More—And We Will
At Blue Cross Blue Shield of Michigan, we’re our members’ advocate, partner and champion for affordable, high-quality health care. We will keep partnering for a system that works better for everyone and provides affordable health insurance that serves as a gateway to quality care.
Image: Getty Images
