CareFirst taps Kurt C. Small as president and CEO

Karl Hille, Baltimore SunBaltimore Sun

CareFirst BlueCross BlueShield has named Kurt C. Small as its next president and CEO, effective May 4.

Small will lead the not-for-profit insurer, which serves about 3.5 million members across Maryland, Virginia and Washington, D.C., with additional reach nationwide. Small replaces Brian Pieninck, who left the firm in September to become CEO of GuideWell Mutual Holding Corp. in Florida.

Small most recently served as president of Medicaid services at Elevance Health, formerly Anthem, a role he held for seven years. Small brings more than 25 years of health care leadership experience, much of it in the mid-Atlantic, with a focus on government and commercial strategy and operations, according to his LinkedIn page.

“I am honored to join CareFirst and build on its mission and long-standing commitment to the region,” Small said in a CareFirst news release. “Together, with executive leaders and the passionate team of Difference Makers, we will build on CareFirst’s legacy and progress to make care simpler, more affordable and more equitable for the people and communities who depend on us to live full and healthy lives.”

Small has a big challenge to face in his new role, said economist Anirban Basu, chairman and CEO of the Baltimore-based Sage Policy Group Inc.

“The job of being a health insurance executive these days is not enviable,” Basu told The Baltimore Sun. “I’m sure the compensation is comforting, but to satisfy all his different stakeholders is near impossible.”

Health insurers like CareFirst are charged with holding down the cost of health care, he said. However, inflation, the aging population, doctors seeking improved compensation, and cuts to federal Medicare and Medicaid funding add strain to the equation.

“How does one ensure health care professionals are willing to stay in the marketplace and accept CareFirst insurance?” he asked. “How does the CEO of CareFirst or any other insurer deal with all these tensions. It’s a very difficult job.”

Small’s LinkedIn profile says that the leader earned his Bachelor of Arts from the College of William and Mary in Williamsburg, Virginia, and a Master of Business Administration from the Yale School of Management.

CareFirst sought up to an 18.7% rate increase for 2026 in the market that includes Maryland, and was approved to raise rates by 13.1% to 13.6%, depending on the individual plans offered, Maryland data shows. The rate jumps for Maryland insurers ranged from 8% at Kaiser Permanente to 15% at UnitedHealthcare in anticipation of the expiration of enhanced federal subsidies at the end of last year.

Meanwhile, the state estimates that health care costs were expected to increase 6.5% this year, including 4.8% for hospital services, 6.1% for physician fees and 10.4% for pharmaceuticals.

An earlier version of this story misspelled the name of Kurt C. Small.

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