Blue Cross of Montana awarded state contract, $28M in savings touted

Sep. 19—Blue Cross and Blue Shield of Montana was awarded the contract to be the third-party administrator for medical benefits and claims administration for the state of Montana Benefit Plan, Montana Department of Administration officials said.

The contract, effective Jan. 1, will result in nearly immediate savings for the self-funded State Plan in 2023, with a projected savings of $28 million over the next three years, benefiting state agencies, state employees and the taxpayers of Montana, Department of Administration (DOA) Director Misty Ann Giles said in a news release.

"Contracting with BCBSMT (Blue Cross and Blue Shield of Montana) will allow us to enhance our ability to be responsible stewards of State Plan contributions while ensuring accessibility to high-quality medical care for State employees," she said.

The contract has been issued for an initial term of three years, with the option to renew for a total of 10 years. BCBSMT was the third-party administrator for the state health plan for nearly 30 years until the state selected a different administrator in 2012. The state will pay BCBSMT to administer medical plan benefits. BCBSMT would potentially pay the state only if it doesn't meet performance guarantees or other contract requirements.

"We are honored to welcome state employees and their families back to the Blue family," said John Doran, Blue Cross Blue Shield of Montana's divisional vice president of external affairs.

"We have already begun to roll up our sleeves and get to work on behalf of state employees and their families to ensure a smooth transition. Providing the highest level of customer service is our top priority," he said.

Cigna served as the state's third party administrator from 2013-2015, then Allegiance Benefit Plan Management served from 2016 to present day, DOA officials said.

A third-party administrator provides administrative services for self-funded health plans. They can also provide access to health care networks and may be able to source more vendors, such as stop-loss insurers. The state sets the benefit design, and the TPA administers every facet of the health plan, including contracting with the provider network, providing customer service, paying claims, aiding in care coordination and sourcing outside vendors to provide ancillary services.

The Request for Proposals was released in March with the goal of finding a vendor to help the DOA streamline the administration of State Plan medical benefits and also modernize its Medicare reimbursement strategy, DOA officials said. Blue Cross was one of six vendors who bid. An evaluation committee scored the bids. BCBSMT received the highest score and was awarded the contract.

The contract includes fees BCBSMT will pay for certain services per employee and the state shall pay BCBSMT within 30 days of the date the monthly billing report is generated.

BCBSMT officials said the savings will be through provider contracts for reimbursement of services and also population health initiatives. They said their contracts are more favorable than the current TPA and the population health initiatives are aimed at improved health outcomes that save costs over the long term.

The state will continue to offer one medical plan for all eligible plan members. Minimal impact is anticipated for members as the transition is completed. Monthly benefit contributions for state employees will remain stable, as will plan member access to participating facilities and care providers. The new contract allows the State Plan to continue improving upon its multiple of Medicare reimbursement strategy by setting specific benchmark levels of reimbursement that BCBSMT is responsible for maintaining.

"This new partnership will allow us to effectively continue serving our 28,000 members who rely on State Plan coverage for affordable and reliable health insurance coverage," said Health Care & Benefits Division Administrator Amy Jenks.

She said it will also provide more opportunities for member engagement and management of medical conditions, including access to more programs and services for members.

Open Enrollment for 2023 will be Oct. 23 to Nov. 5. Open Enrollment is an annual opportunity for plan members to review benefit elections and changes plans or covered dependents for the coming calendar year.

The State Plan is self-funded by the state and includes medical, prescription drug, dental and vision plans.

The state provides health benefits to state employees, retirees (non-Medicare and Medicare), legislators, Consolidated Omnibus Budget Reconciliation Act (COBRA) enrollees, and their dependents who are referred to as plan members. DOA's Health Care & Benefits Division is responsible for the administration of the State Plan, which includes the self-funded medical plan.

BCBSMT has operated in Montana since 1940 and provides more than 300,000 members with plans. BCBSMT employs nearly 600 people in five locations, with offices in Helena, Billings, Bozeman, Great Falls and Kalispell.

Assistant editor Phil Drake can be reached at 406-231-9021.

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