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{{short description|Company}}
{{Short description|American mutual benefit corporation}}
{{Use American English|date=May 2021}}
{{Use mdy dates|date=April 2021}}
{{Infobox company
{{Infobox company
| name = Blue Shield of California
| name = Blue Shield of California
| logo = Blue Shield of California.svg
| logo = Blue Shield of California logo.png
| logo_size = 250px
| logo_size =
| type = Non-Profit Health Plan (tax exempt status removed in 2014)<ref name=Mission>{{Cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/corporate/values.sp|title=Mission and Values - Blue Shield of California|website=blueshieldca.com|access-date=2016-03-17}}</ref><ref name=Stripped>{{Cite web|url=https://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html|title=With billions in the bank, Blue Shield of California loses its state tax-exempt status|website=Los Angeles Times|access-date=2016-09-01}}</ref>
| type = Non-profit health plan (tax exempt status removed in 2014)<ref name=Mission>{{Cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/corporate/values.sp|title=Mission and Values – Blue Shield of California|website=blueshieldca.com|access-date=March 17, 2016}}</ref><ref name=Stripped>{{Cite web|url=https://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html|title=With billions in the bank, Blue Shield of California loses its state tax-exempt status|website=Los Angeles Times|date=March 18, 2015 |access-date=September 1, 2016}}</ref>
| founder = [[California Medical Association]]<ref name=History>{{Cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/corporate/history.sp|title=Corporate History and Timeline - Blue Shield of California|website=blueshieldca.com|access-date=2016-03-17}}</ref>
| founder = [[California Medical Association]]<ref name=History>{{Cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/corporate/history.sp|title=Corporate History and Timeline – Blue Shield of California|website=blueshieldca.com|access-date=March 17, 2016}}</ref>
| key_people = Paul Markovich,<br/>''President and [[CEO|chief executive]]''
| key_people = Paul Markovich,<br />President and [[chief executive]]
| industry = Healthcare
| industry = Healthcare
| revenue = {{increase}} $20.6 billion [[U.S. Dollar|USD]] (2018)<ref name=FY>{{Cite web|url=https://www.blueshieldca.com/about/corporate-info/financial|title=Financials - Blue Shield of California|website=blueshieldca.com/about/corporate-info/financial}}</ref>
| revenue = {{increase}} $21.8 billion [[U.S. Dollar|USD]] (2020)<ref name="2020Financials" />
| net_income = {{increase}} $413 million [[U.S. Dollar|USD]] (2018)<ref name=FY/>
| net_income = {{increase}} $680 million USD (2020)<ref name="2020Financials" />
| members = {{increase}} 4.5 million (2021)<ref name="FactPDF">{{Cite web|date=2021|title=Fact sheet|url=https://s3.amazonaws.com/cms.ipressroom.com/347/files/20212/BlueShieldCA_Fact_Sheet_March+2021.pdf|url-status=live|website=Blue Shield of California|archive-url=https://web.archive.org/web/20210512003139/https://s3.amazonaws.com/cms.ipressroom.com/347/files/20212/BlueShieldCA_Fact_Sheet_March+2021.pdf |archive-date=May 12, 2021 }}</ref>
| members = {{increase}} 4.3 million (June 2019) <ref name=FY/>
| num_employees = 6,808 (2018)
| num_employees = 7,500 (2021)<ref name="FactPDF" />
| homepage = [http://www.blueshieldca.com/ blueshieldca.com]
| homepage = {{URL|https://blueshieldca.com}}
| foundation = 1938 (created)<ref name=History/><br/>1939 (incorporated)<ref name=History/>
| foundation = 1938 (created)<ref name=History /><br />1939 (incorporated)<ref name=History />
| location = 601 12th Street<br>[[Oakland, California|Oakland]], California|
| location = 601 12th Street<br />[[Oakland, California|Oakland]], California|
}}
}}


'''Blue Shield of California''' is a mutual benefit corporation and [[health plan]]<ref name=":1">{{Cite web|last1=Young|first1=Samantha|last2=Hart|first2=Angela|date=March 22, 2021|title=Newsom Awarded the No-Bid Vaccine Contract to Blue Shield, a Trusted and Generous Supporter|url=https://www.kqed.org/science/1973320/newsom-awarded-the-no-bid-vaccine-contract-to-blue-shield-a-trusted-and-generous-supporter|url-status=live|access-date=2021-05-07|website=KQED|language=en-us|archive-url=https://web.archive.org/web/20210323012250/https://www.kqed.org/science/1973320/newsom-awarded-the-no-bid-vaccine-contract-to-blue-shield-a-trusted-and-generous-supporter |archive-date=March 23, 2021 }}</ref><ref>{{Cite web|last=Terhune|first=Chad|date=2015-06-06|title=Blue Shield faces more heat over nonprofit status, $1.2-billion deal|url=https://www.latimes.com/business/la-fi-blue-shield-nonprofit-20150605-story.html|url-status=live|access-date=2021-05-07|website=Los Angeles Times|language=en-US|archive-url=https://web.archive.org/web/20150606011831/http://www.latimes.com/business/la-fi-blue-shield-nonprofit-20150605-story.html |archive-date=June 6, 2015 }}</ref> founded in 1939 by the [[California Medical Association]]. It is based in [[Oakland, California|Oakland]], California, and serves 4.5 million health plan members and more than 65,000 physicians across the state. Blue Shield of California was founded as a not-for-profit organization. As of 2014, it is no longer tax-exempt in California and has been paying federal taxes for several years before that.<ref name="Stripped" />
'''Blue Shield of California''' is a [[health plan]] provider founded in 1939<ref name=History/>. It is based in [[Oakland, California|Oakland]], California and serves over 4 million health plan members and nearly 65,000 physicians across the state.<ref name="Blue Shield Facts">{{cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/corporate/fast-facts.sp|title=Company Facts and Network Statistics - Blue Shield of California|date=28 January 2016|work=blueshieldca.com}}</ref> Blue Shield of California was founded by the [[California Medical Association]]. Founded as a not-for-profit, Blue Shield of California was stripped of its tax-exempt status by the California Franchise Tax Board in 2014.<ref name="Stripped" />


==History==
== History ==
Blue Shield of California, then known as California Physicians' Service, was created by the California Medical Association on December 18, 1938,<ref name="Blue Shield Timeline">{{cite web|url=https://www.blueshieldca.com/bsc/newsroom/newsroom_02.jhtml|title=Corporate History and Timeline - Blue Shield of California|date=12 September 2011|work=blueshieldca.com}}</ref> and was incorporated on August 9, 1939. The organization began offering coverage on March 6 of that same year. In 1946, the organization was among a founder of the National Association of Blue Shield Plans, which later became the [[Blue Cross and Blue Shield Association]]. Today, Blue Shield of California is an independent licensee of the national association.
Blue Shield of California, then known as California Physicians' Service, was created by the California Medical Association in 1938. The organization was incorporated in 1939 and began offering coverage on March 6 of that same year. In 1946, the organization was among the founders of the National Association of Blue Shield Plans, which later became the [[Blue Cross and Blue Shield Association]].<ref name="Blue Shield Timeline">{{cite web|date=September 12, 2011|title=Corporate History and Timeline|url=https://www.blueshieldca.com/bsc/newsroom/newsroom_02.jhtml|url-status=live|access-date=May 3, 2021|work=Blue Shield of California|archive-url=https://web.archive.org/web/20060322045851/https://www.blueshieldca.com/bsc/newsroom/newsroom_02.jhtml |archive-date=March 22, 2006 }}</ref> In 1950, the Blue Shield of California health plan began offering [[catastrophic coverage]].<ref name="Blue Shield Timeline" /><ref>{{Cite book|last=Dickinson|first=Frank G.|url=https://books.google.com/books?id=ZTUghWGjMlAC&pg=PA103|title=Medical Care in Transition|date=1964|publisher=U.S. Department of Health, Education, and Welfare, Public Health Service|others=Reprints from the [[American Journal of Public Health]]|volume=1|pages=103|language=en|oclc=1012029666}}</ref> By 1961, it had one million subscribers of its health plan.<ref name="Blue Shield Timeline" /> From 1966 to 2018, the organization was headquartered at [[50 Beale Street]] in San Francisco.<ref name="oakland">{{cite news | url=https://www.bizjournals.com/sanfrancisco/news/2017/03/08/blue-shield-oakland-lease-shorenstein-office-tower.html |title=Blue Shield to move headquarters from San Francisco to Oakland with massive lease | first=Roland | last=Li | work=[[American City Business Journals]] | date=March 8, 2017}}</ref>
The Blue Shield of California health plan was the first in the nation to offer catastrophic coverage in 1950, provide coverage for a heart transplant in 1984, offer online benefit and enrollment information in 1996, and offer an online enrollment system for agents in 1998. In 2006, the [[National Committee for Quality Assurance]], commonly referred to as NCQA, recently recognized Blue Shield as an "excellent" health plan for service and clinical quality.


In 1984, it began covering [[heart transplantation]]s offered at [[Stanford University Medical Center]].<ref>{{Cite journal|last=Evans|first=Roger W.|date=January 1987|title=The economics of heart transplantation.|journal=Circulation|language=en|volume=75|issue=1|pages=73|doi=10.1161/01.CIR.75.1.63|pmid=3098447 |doi-access=free}}</ref>
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The Blue Cross of California, which traditionally covered the hospital portion of insurance, was a separate entity which went public in 1992 under the name Wellpoint, with the name later changing to [[Anthem (company)|Anthem]].<ref>{{Cite web|url=https://www.indystar.com/story/money/2014/12/03/call-us-wellpoint-says-newly-named-anthem/19827633/|title=Don’t call us WellPoint, says newly named Anthem|website=Indianapolis Star|access-date=2019-05-24}}</ref>


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The Blue Cross of California, which traditionally covered the hospital portion of insurance as a separate entity, went public in 1992 under the name Wellpoint, with the name later changing to [[Anthem (company)|Anthem]].<ref>{{Cite web|url=https://www.indystar.com/story/money/2014/12/03/call-us-wellpoint-says-newly-named-anthem/19827633/|title=Don't call us WellPoint, says newly named Anthem|website=Indianapolis Star|access-date=May 24, 2019}}</ref> Blue Shield began offering information on benefits and enrollment on the Internet in 1996, and offering an online enrollment system for agents in 1998.<ref name="Blue Shield Timeline" /> In 1997, Blue Shield acquired the managed care company CareAmerica.<ref>{{cite web | url=https://californiahealthline.org/morning-breakout/blue-shield-of-california-acquires-careamerica/ | title=Blue Shield of California: Acquires Careamerica }}</ref>
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In 2010, Blue Shield of California, [[Dignity Health]], and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in the California Public Employees Retirement System ([[CalPERS]]). During its first 2 years, this program reduced inpatient use and [[health care prices in the United States|health care costs]] significantly.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/accountable-care-organization-featuring-shared-global-risk-stimulates-development |title=Accountable Care Organization Featuring Shared Global Risk Stimulates Development of Initiatives To Improve Care, Reduces Inpatient Use and Costs |date=2013-05-08 |accessdate=2013-05-09}}</ref>


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In 2006, Blue Shield agreed to a $6.5 million settlement relating to allegedly modifying the [[risk]] tier structure of its individual and family health care plans. In 2008, the organization settled for $3 million with the [[California Department of Managed Health Care]] to resolve allegations of improper [[Rescission (contract law)|rescission]] of individual health plan coverage. Further, the organization reinstated coverage to 450 members whose plans had been canceled and agreed to provide compensation for any [[medical debt]]s incurred by these policyholders due to the rescission.<ref>{{cite news|date=July 18, 2008|title=2 health insurers to pay $13M to Calif. regulators|publisher=AP/Google|url=http://ap.google.com/article/ALeqM5gDBLyPh2QHiIO7azoVYF9Q2TVRSwD9203RSG2|url-status=dead|accessdate=July 18, 2008|archiveurl=https://web.archive.org/web/20080721053636/http://ap.google.com/article/ALeqM5gDBLyPh2QHiIO7azoVYF9Q2TVRSwD9203RSG2|archivedate=July 21, 2008}}</ref>
In 2014, Blue Shield of California lost its exemption from California state corporate income tax but did not officially announce this information to the public until March 2015.<ref name=Stripped/> A claimed recent application of the [[duck test]] was the denial of tax-exempt "nonprofit" status to Blue Shield of California.<ref name="Seipel">{{cite news |title=California drops hammer on Blue Shield tax-exempt status |first1=Tracy |last1=Seipel |url=http://www.mercurynews.com/health/ci_27749247/california-drops-hammer-blue-shield-tax-exempt-status |newspaper=[[San Jose Mercury News]] |date=March 19, 2015 |accessdate=March 19, 2015}}</ref>


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In 2010, Blue Shield of California, [[Dignity Health]], and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in the California Public Employees Retirement System ([[CalPERS]]). During its first 2 years, this program reduced inpatient use and [[health care prices in the United States|health care costs]] significantly.<ref>{{cite web |publisher=Agency for Healthcare Research and Quality |url=https://innovations.ahrq.gov/profiles/accountable-care-organization-featuring-shared-global-risk-stimulates-development |title=Accountable Care Organization Featuring Shared Global Risk Stimulates Development of Initiatives To Improve Care, Reduces Inpatient Use and Costs |date=May 8, 2013 |accessdate=May 9, 2013}}</ref>
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In 2015, Blue Shield entered the [[Medicaid]] market by acquiring Care1st Health Plan.<ref>{{cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/media-center/blue-shield-of-california-care1st-acquisition-100815.sp|title=Blue Shield of California Closes on Acquisition of Care1st, Enters Medi-Cal/Medicaid|publisher=Blue Shield}}</ref> Blue Shield sold Care1st Arizona to [[WellCare]] in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.<ref>{{Cite web| title = Care1st Health Plan Changing Its Name| work = L.A. Care Health Plan| accessdate = 2019-06-21| date = 2018-12-13| url = http://www.lacare.org/tl/node/27946}}</ref>


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In 2015, Blue Shield entered the [[Medicaid]] market by acquiring Care1st Health Plan.<ref>{{cite web|url=https://www.blueshieldca.com/bsca/about-blue-shield/media-center/blue-shield-of-california-care1st-acquisition-100815.sp|title=Blue Shield of California Closes on Acquisition of Care1st, Enters Medi-Cal/Medicaid|publisher=Blue Shield}}</ref> Blue Shield sold Care1st Arizona to [[WellCare]] in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.<ref>{{Cite web| title = Care1st Health Plan Changing Its Name| work = L.A. Care Health Plan| accessdate = June 21, 2019| date = December 13, 2018| url = http://www.lacare.org/tl/node/27946}}</ref>
== Programs ==


In 2019, Blue Shield of California launched the healthcare company Altais. In 2020, Altais acquired the San Francisco practice Brown & Tolland.<ref>{{cite web | url=https://www.hcinnovationgroup.com/population-health-management/care-management/article/21164260/in-northern-california-two-organizations-partner-to-support-independent-md-practices-around-value | title=In Northern California, Two Organizations Partner to Support Independent MD Practices Around Value | date=November 25, 2020 }}</ref>
=== Health Reimagined Initiative ===
It is an ambitious, systematic initiative to expand access to quality health care while making it more accessible. The program uses the latest advances and technology, as well as partnerships with medical professionals, employers, community leaders and others to improve the patients , families, and neighborhoods healthcare system.<ref>{{Cite web|last=|first=|date=16 June 2020|title=Blue Shield of California Health Reimagined Initiative to Transform Health Care for Individuals, Communities Throughout California|url=https://www.prnewswire.com/news-releases/blue-shield-of-california-health-reimagined-initiative-to-transform-health-care-for-individuals-communities-throughout-california-301077353.html|url-status=live|archive-url=|archive-date=|access-date=10 July 2020|website=PR Newswire}}</ref>


==Community outreach==
== Network ==
Blue Shield of California's provider network currently includes 65,000 physicians<ref>{{Cite web|last=Pena|first=Luz|date=March 3, 2021|title=Blue Shield CEO explains plan to increase CA's vaccine doses to 4M per week|url=https://abc7news.com/10384170/|url-status=live|access-date=April 30, 2021|website=ABC7 San Francisco|language=en|archive-url=https://web.archive.org/web/20210303034249/https://abc7news.com/10384170/ |archive-date=March 3, 2021 }}</ref> and more than 340 hospitals statewide.<ref>{{cite web|date=June 2018|title=Fact Sheet|url=https://news.blueshieldca.com/internal_redirect/cms.ipressroom.com.s3.amazonaws.com/347/files/20185/Fact%20Sheet%20DRAFT04_graphical_201806201759.pdf|url-status=live|access-date=April 30, 2021|website=Blue Shield of California – News Center|archive-url=https://web.archive.org/web/20191006022039/https://news.blueshieldca.com/internal_redirect/cms.ipressroom.com.s3.amazonaws.com/347/files/20185/Fact%20Sheet%20DRAFT04_graphical_201806201759.pdf |archive-date=October 6, 2019 }}</ref>
* Blue Shield has donated more than $500 million to Blue Shield of California Foundation since 2002, including $39 million in 2017
* The Foundation awarded $25 million in grants in 2017 to advance the well-being of all Californians, particularly our state's most vulnerable populations.
* Employees volunteered 26,000 hours in 2017.
* Employees donated $474,000 to charities in 2017, with matching gifts by Blue Shield.


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In the California Healthcare Quality Report Card 2009 Edition, Blue Shield of California received 3 out of 4 stars in Meeting National Standards of Care and 2 out of 4 stars in How Members Rate Their HMO.<ref>[http://www.opa.ca.gov/report_card/hmorating.aspx State of California – Health Care Quality Report Card 2009 Edition] {{webarchive|url=https://web.archive.org/web/20110719035537/http://www.opa.ca.gov/report_card/hmorating.aspx?utm_source=Wiki-BlueShield&utm_medium=QualityofCare&utm_campaign=Wikipedia|date=July 19, 2011}}</ref>
==Diversity & inclusion==
* 84% of Blue Shield of California's 6,800 employees rated the company a great place to work in 2017.
* Blue Shield was named as a Top Regional Company by Diversity Inc. in 2017
* Women make up 68% of Blue Shield's workforce
* The company earned a 100% score on Human Rights Campaign’ Corporate Equality Index survey and was named one of the Best Places to Work for LGBTQ equality
* Blue Shield of California was recognized in 2017 as a 2020 Women on Boards Winning 'W' Company for championing board diversity


==Network==
== Financial ==
In 2011, Blue Shield announced that it would cap its net income at no more than 2% of revenue, contingent on approval from the board of directors.<ref>{{Cite web|last=Brown|first=Steven E.F.|date=2011-06-07|title=Blue Shield of California to limit profit to 2% of revenue|url=https://www.bizjournals.com/sanfrancisco/news/2011/06/07/blue-shield-of-california-to-limit.html|url-status=live|access-date=2021-05-07|website=San Francisco Business Times|archive-url=https://web.archive.org/web/20110610165344/http://www.bizjournals.com:80/sanfrancisco/news/2011/06/07/blue-shield-of-california-to-limit.html? |archive-date=June 10, 2011 }}</ref> As of 2019, more than $600 million has been returned to customers and the community as a result of the pledge.<ref>{{Cite web|date=2020|title=Financials|url=https://www.blueshieldca.com/bsca/bsc/public/member/mp/contentpages/!ut/p/z1/tVFLc4IwEP4r9eCRyRIohCNaX0ytM1ar5sIkGCQdSBCjtv--wbG9VaeH5rSZ_Xb3eyCK1ogqdpI7ZqRWrLT_DQ1STCZkDOAmM8AAMYF-8hJFhIQhekMU0TqTW7TBgRv6goMTbrHr-BhCJ-KZ70SPImKZ4Dx3eYvOlKlNgTaVqLho0kwrI5RJherCtX5otDZdYFwfTcrLo0gPhRTltgU0tW6YEalUuW6qC88u5FIxlUlWHtDqHmNq2_DLiwEl9wDWEtxM-9Od1c1M4bRE0LrWmT1NL8M_x0eLvgfxaBB7Q7L0iO9fATe2byz9ME0IBJPeDJ7hlYQQPw3mvXiIMYxctDpJcUZL1Yov0esf7R9_C7xhkBUo3_d7Gtuo2jw-DFr_T1Z1VRHv06E8mJPzIi_KXafzBQ4jais!/dz/d5/L2dBISEvZ0FBIS9nQSEh/|url-status=live|access-date=May 7, 2021|website=Blue Shield of California|archive-url=https://web.archive.org/web/20200418231232/https://www.blueshieldca.com/bsca/bsc/public/member/mp/contentpages/!ut/p/z1/tVFLc4IwEP4r9eCRyRIohCNaX0ytM1ar5sIkGCQdSBCjtv--wbG9VaeH5rSZ_Xb3eyCK1ogqdpI7ZqRWrLT_DQ1STCZkDOAmM8AAMYF-8hJFhIQhekMU0TqTW7TBgRv6goMTbrHr-BhCJ-KZ70SPImKZ4Dx3eYvOlKlNgTaVqLho0kwrI5RJherCtX5otDZdYFwfTcrLo0gPhRTltgU0tW6YEalUuW6qC88u5FIxlUlWHtDqHmNq2_DLiwEl9wDWEtxM-9Od1c1M4bRE0LrWmT1NL8M_x0eLvgfxaBB7Q7L0iO9fATe2byz9ME0IBJPeDJ7hlYQQPw3mvXiIMYxctDpJcUZL1Yov0esf7R9_C7xhkBUo3_d7Gtuo2jw-DFr_T1Z1VRHv06E8mJPzIi_KXafzBQ4jais!/dz/d5/L2dBISEvZ0FBIS9nQSEh/ |archive-date=April 18, 2020 }}</ref>
Blue Shield of California's provider network currently includes 58,000 physicians and more than 340 hospitals statewide.<ref>{{cite web|url=https://news.blueshieldca.com/about/fact-sheet|title=Fact Sheet|website=Blue Shield of California - News Center}}</ref>


In 2014, Blue Shield of California lost its exemption from California state corporate income tax. This information became public in March 2015.<ref name=":0">{{cite web|last=Terhune|first=Chad|date=2015-03-18|title=With billions in the bank, Blue Shield of California loses its state tax-exempt status|url=https://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html|url-status=live|access-date=May 7, 2021|website=Los Angeles Times|archive-url=https://web.archive.org/web/20150318173005/http://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html |archive-date=March 18, 2015 }}</ref> A claimed recent application of the [[duck test]] resulted in the denial of Blue Shield's tax-exempt status.<ref name="Seipel">{{cite news|last1=Seipel|first1=Tracy|date=March 19, 2015|title=California drops hammer on Blue Shield tax-exempt status|newspaper=[[San Jose Mercury News]]|url=http://www.mercurynews.com/health/ci_27749247/california-drops-hammer-blue-shield-tax-exempt-status|accessdate=March 19, 2015}}</ref> This was after "a lengthy state audit that looked at the justification for Blue Shield's taxpayer subsidy." Blue Shield holds billions in cash reserves and spends millions in executive pay. The organization defended its tax-exempt status, but failed to provide sufficient evidence to [[California Franchise Tax Board]] that its actions align with such obligations.<ref name=":0" /> As a result, Blue Shield became a tax-paying nonprofit.<ref name=":1" />
Blue Shield established 42 [[accountable care organization]] (ACO) partnerships across the state.{{Citation needed|date=February 2019}} Since 2010, Blue Shield's ACO program has:{{Citation needed|date=February 2019}}


In 2020, Blue Shield of California reported $21.8 billion in revenue and $680 million in net income.<ref name="2020Financials">{{Cite web|date=2020|title=Blue Shield of California Consolidated Financials|url=https://s3.amazonaws.com/cms.ipressroom.com/347/files/20213/Blue%20Shield%20of%20California%20Consolidated%20Financials%202020.pdf|access-date=May 7, 2021|website=Blue Shield of California}}</ref>
* Cut the number of days patients stay in the hospital by 16%
* Reduced hospital re-admissions by 13%
* Reduced their patient care expenditure by $480 million


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== References ==
Other examples of Blue Shield's efforts to transform health care include:{{Citation needed|date=February 2019}}
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{{Reflist|30em}}


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== External links ==
* Investing $30 million in a multi-year collaboration with the California Medical Association to develop and support a new health care model that will bring health care into the digital age, tie pay to value and create a patient-centered experience through home- and community-based services.
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*{{Official website|https://blueshieldca.com}}
* Collaborating with Manifest MedEx, one of the nation's largest nonprofit health information exchanges, to advance secure health information sharing between providers, plans and ultimately consumers.
* Providing home-based palliative care and 24/7 support to select members with serious illness in all 58 counties in California - the only health plan in the state to offer this service.
* Offering 24/7 house calls for chronically ill patients who have at least 6 of 13 debilitating illnesses, through a collaboration with Landmark, which delivers home-based medical and behavioral care and social support services.


{{Authority control}}
==Financial==
2% Pledge: Blue Shield voluntarily caps its net income at 2% of revenue, with approval from the board of directors. More than $596 million has been returned to customers and the community a result of the pledge.<ref>[https://www.blueshieldca.com/about/corporate-info/facts Blue Shield of California - Fast Facts]</ref>


Blue Shield of California was recognized as one of 2018 World's Most Ethical Companies® by the Ethisphere Institute – the sixth time to have received the honor.

Financial Performance:<ref name="FP">{{Cite web|last=|first=|date=|title=Blue Shield of California - Fast Facts|url=https://www.blueshieldca.com/bsca/bsc/public/member/mp/contentpages/!ut/p/z1/tVFLc4IwEP4r9eCRyQoI8YjUF1PrjI8quWQSCEIHEsSo7b9vcGxv1emhOW1mv939HoigHSKSnYs904WSrDT_mHjUxjM8BehFC7ABAgxh9DoYYOz76A0RROqkSFHsZH3fFcy2OOPMcn3hWDz1uNWzxYDhLHX6ideiE6lrnaO4EhUXDU2U1EJqKmQXbvVTo5TuAuPqpCkvT4Ie80KUaQtoatUwLWghM9VUV55dyNhR04wl-oi2jxgT04ZfXgAoegQwltjNPJzvjW6mc6slgna1Ssxpch3-OT5Zhw4Ek1HgjPHGwa57A9zZHhv6Po0weLPhAl5ghX0InkfLYTC2bZj00PZciAvayFZ8iVZ_tH_6LfCOQUZg8X44kMBE1ebxodHuf7Kqqwo7nxbh3hJf1lle7judLziEvRw!/dz/d5/L2dBISEvZ0FBIS9nQSEh/|url-status=live|archive-url=|archive-date=|access-date=4 August 2020|publisher=Blue Shield California}}</ref>

* $20.6 Billion in revenue in 2018
* $413 Million net income in 2018
* A+ rating from Fitch Ratings for Blue Shield of California
* A (excellent) rating from AM Best for California Physicians' Service
* A+ (excellent) rating by Weiss Ratings for California Physicians' Service

In 2015, Blue Shield of California was stripped of its state tax exempt status following "a lengthy state audit that looked at the justification for Blue Shield's taxpayer subsidy." Such a finding indicates that the organization failed to act for the public good as required for exempt status. The organization holds billions in cash reserves, spends millions in executive pay, and provides no services for [[Medi-Cal]] recipients. The organization defends its non-profit status, but has failed to provide sufficient evidence that its actions align with such obligations.<ref>{{cite web|url=https://www.latimes.com/business/la-fi-blue-shield-california-20150318-story.html|title=With billions in the bank, Blue Shield of California loses its state tax-exempt status|first=Chad|last=Terhune|website=Los Angeles Times}}</ref>

==Quality of care==
⚫
In the California Healthcare Quality Report Card 2009 Edition, Blue Shield of California received 3 out of 4 stars in Meeting National Standards of Care and 2 out of 4 stars in How Members Rate Their HMO.<ref>[http://www.opa.ca.gov/report_card/hmorating.aspx State of California - Health Care Quality Report Card 2009 Edition] {{webarchive |url=https://web.archive.org/web/20110719035537/http://www.opa.ca.gov/report_card/hmorating.aspx?utm_source=Wiki-BlueShield&utm_medium=QualityofCare&utm_campaign=Wikipedia |date=July 19, 2011 }}</ref>

==Controversy==
⚫
In 2006, Blue Shield agreed to a $6.5 million settlement relating to allegedly modifying the [[risk]] tier structure of its individual and family health care plans. In 2008, the organization settled for $3 million with the [[California Department of Managed Health Care]] to resolve allegations of improper [[Rescission (contract law)|rescission]] of individual health plan coverage. Further, the organization reinstated coverage to 450 members whose plans had been cancelled and agreed to provide compensation for any [[medical debt]]s incurred by these policyholders due to the rescission.<ref>{{cite news |url=http://ap.google.com/article/ALeqM5gDBLyPh2QHiIO7azoVYF9Q2TVRSwD9203RSG2 |title=2 health insurers to pay $13M to Calif. regulators |publisher=AP/Google |date=2008-07-18 |accessdate=2008-07-18 |url-status=dead |archiveurl=https://web.archive.org/web/20080721053636/http://ap.google.com/article/ALeqM5gDBLyPh2QHiIO7azoVYF9Q2TVRSwD9203RSG2 |archivedate=2008-07-21 }}</ref>

⚫
==References==
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{{reflist|30em}}

⚫
==External links==
⚫
*{{official|http://blueshieldca.com}}
*[https://web.archive.org/web/20110719035544/http://www.opa.ca.gov/report_card/?utm_source=Wiki-BlueShield&utm_medium=QualityofCare&utm_campaign=Wikipedia California Healthcare Quality Report Card 2009 Edition]

{{DEFAULTSORT:Blue Shield of California}}
[[Category:Health insurance in the United States]]
[[Category:Health insurance in the United States]]
[[Category:Insurance companies of the United States]]
[[Category:Members of Blue Cross Blue Shield Association]]
[[Category:Members of Blue Cross Blue Shield Association]]
[[Category:American companies established in 1939]]
[[Category:American companies established in 1939]]

Latest revision as of 08:57, 31 August 2024

Blue Shield of California
Company typeNon-profit health plan (tax exempt status removed in 2014)[1][2]
IndustryHealthcare
Founded1938 (created)[3]
1939 (incorporated)[3]
FounderCalifornia Medical Association[3]
Headquarters601 12th Street
Oakland, California
Key people
Paul Markovich,
President and chief executive
RevenueIncrease $21.8 billion USD (2020)[4]
Increase $680 million USD (2020)[4]
MembersIncrease 4.5 million (2021)[5]
Number of employees
7,500 (2021)[5]
Websiteblueshieldca.com

Blue Shield of California is a mutual benefit corporation and health plan[6][7] founded in 1939 by the California Medical Association. It is based in Oakland, California, and serves 4.5 million health plan members and more than 65,000 physicians across the state. Blue Shield of California was founded as a not-for-profit organization. As of 2014, it is no longer tax-exempt in California and has been paying federal taxes for several years before that.[2]

History

[edit]

Blue Shield of California, then known as California Physicians' Service, was created by the California Medical Association in 1938. The organization was incorporated in 1939 and began offering coverage on March 6 of that same year. In 1946, the organization was among the founders of the National Association of Blue Shield Plans, which later became the Blue Cross and Blue Shield Association.[8] In 1950, the Blue Shield of California health plan began offering catastrophic coverage.[8][9] By 1961, it had one million subscribers of its health plan.[8] From 1966 to 2018, the organization was headquartered at 50 Beale Street in San Francisco.[10]

In 1984, it began covering heart transplantations offered at Stanford University Medical Center.[11]

The Blue Cross of California, which traditionally covered the hospital portion of insurance as a separate entity, went public in 1992 under the name Wellpoint, with the name later changing to Anthem.[12] Blue Shield began offering information on benefits and enrollment on the Internet in 1996, and offering an online enrollment system for agents in 1998.[8] In 1997, Blue Shield acquired the managed care company CareAmerica.[13]

In 2006, Blue Shield agreed to a $6.5 million settlement relating to allegedly modifying the risk tier structure of its individual and family health care plans. In 2008, the organization settled for $3 million with the California Department of Managed Health Care to resolve allegations of improper rescission of individual health plan coverage. Further, the organization reinstated coverage to 450 members whose plans had been canceled and agreed to provide compensation for any medical debts incurred by these policyholders due to the rescission.[14]

In 2010, Blue Shield of California, Dignity Health, and Hill Physicians Medical Group formed an Accountable Care Organization that covers 41,000 individuals in the California Public Employees Retirement System (CalPERS). During its first 2 years, this program reduced inpatient use and health care costs significantly.[15]

In 2015, Blue Shield entered the Medicaid market by acquiring Care1st Health Plan.[16] Blue Shield sold Care1st Arizona to WellCare in 2017. Care1st California was renamed Blue Shield of California Promise Health Plan in 2019.[17]

In 2019, Blue Shield of California launched the healthcare company Altais. In 2020, Altais acquired the San Francisco practice Brown & Tolland.[18]

Network

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Blue Shield of California's provider network currently includes 65,000 physicians[19] and more than 340 hospitals statewide.[20]

In the California Healthcare Quality Report Card 2009 Edition, Blue Shield of California received 3 out of 4 stars in Meeting National Standards of Care and 2 out of 4 stars in How Members Rate Their HMO.[21]

Financial

[edit]

In 2011, Blue Shield announced that it would cap its net income at no more than 2% of revenue, contingent on approval from the board of directors.[22] As of 2019, more than $600 million has been returned to customers and the community as a result of the pledge.[23]

In 2014, Blue Shield of California lost its exemption from California state corporate income tax. This information became public in March 2015.[24] A claimed recent application of the duck test resulted in the denial of Blue Shield's tax-exempt status.[25] This was after "a lengthy state audit that looked at the justification for Blue Shield's taxpayer subsidy." Blue Shield holds billions in cash reserves and spends millions in executive pay. The organization defended its tax-exempt status, but failed to provide sufficient evidence to California Franchise Tax Board that its actions align with such obligations.[24] As a result, Blue Shield became a tax-paying nonprofit.[6]

In 2020, Blue Shield of California reported $21.8 billion in revenue and $680 million in net income.[4]

References

[edit]
  1. ^ "Mission and Values – Blue Shield of California". blueshieldca.com. Retrieved March 17, 2016.
  2. ^ a b "With billions in the bank, Blue Shield of California loses its state tax-exempt status". Los Angeles Times. March 18, 2015. Retrieved September 1, 2016.
  3. ^ a b c "Corporate History and Timeline – Blue Shield of California". blueshieldca.com. Retrieved March 17, 2016.
  4. ^ a b c "Blue Shield of California Consolidated Financials" (PDF). Blue Shield of California. 2020. Retrieved May 7, 2021.
  5. ^ a b "Fact sheet" (PDF). Blue Shield of California. 2021. Archived (PDF) from the original on May 12, 2021.
  6. ^ a b Young, Samantha; Hart, Angela (March 22, 2021). "Newsom Awarded the No-Bid Vaccine Contract to Blue Shield, a Trusted and Generous Supporter". KQED. Archived from the original on March 23, 2021. Retrieved May 7, 2021.
  7. ^ Terhune, Chad (June 6, 2015). "Blue Shield faces more heat over nonprofit status, $1.2-billion deal". Los Angeles Times. Archived from the original on June 6, 2015. Retrieved May 7, 2021.
  8. ^ a b c d "Corporate History and Timeline". Blue Shield of California. September 12, 2011. Archived from the original on March 22, 2006. Retrieved May 3, 2021.
  9. ^ Dickinson, Frank G. (1964). Medical Care in Transition. Vol. 1. Reprints from the American Journal of Public Health. U.S. Department of Health, Education, and Welfare, Public Health Service. p. 103. OCLC 1012029666.
  10. ^ Li, Roland (March 8, 2017). "Blue Shield to move headquarters from San Francisco to Oakland with massive lease". American City Business Journals.
  11. ^ Evans, Roger W. (January 1987). "The economics of heart transplantation". Circulation. 75 (1): 73. doi:10.1161/01.CIR.75.1.63. PMID 3098447.
  12. ^ "Don't call us WellPoint, says newly named Anthem". Indianapolis Star. Retrieved May 24, 2019.
  13. ^ "Blue Shield of California: Acquires Careamerica".
  14. ^ "2 health insurers to pay $13M to Calif. regulators". AP/Google. July 18, 2008. Archived from the original on July 21, 2008. Retrieved July 18, 2008.
  15. ^ "Accountable Care Organization Featuring Shared Global Risk Stimulates Development of Initiatives To Improve Care, Reduces Inpatient Use and Costs". Agency for Healthcare Research and Quality. May 8, 2013. Retrieved May 9, 2013.
  16. ^ "Blue Shield of California Closes on Acquisition of Care1st, Enters Medi-Cal/Medicaid". Blue Shield.
  17. ^ "Care1st Health Plan Changing Its Name". L.A. Care Health Plan. December 13, 2018. Retrieved June 21, 2019.
  18. ^ "In Northern California, Two Organizations Partner to Support Independent MD Practices Around Value". November 25, 2020.
  19. ^ Pena, Luz (March 3, 2021). "Blue Shield CEO explains plan to increase CA's vaccine doses to 4M per week". ABC7 San Francisco. Archived from the original on March 3, 2021. Retrieved April 30, 2021.
  20. ^ "Fact Sheet" (PDF). Blue Shield of California – News Center. June 2018. Archived (PDF) from the original on October 6, 2019. Retrieved April 30, 2021.
  21. ^ State of California – Health Care Quality Report Card 2009 Edition Archived July 19, 2011, at the Wayback Machine
  22. ^ Brown, Steven E.F. (June 7, 2011). "Blue Shield of California to limit profit to 2% of revenue". San Francisco Business Times. Archived from the original on June 10, 2011. Retrieved May 7, 2021.
  23. ^ "Financials". Blue Shield of California. 2020. Archived from the original on April 18, 2020. Retrieved May 7, 2021.
  24. ^ a b Terhune, Chad (March 18, 2015). "With billions in the bank, Blue Shield of California loses its state tax-exempt status". Los Angeles Times. Archived from the original on March 18, 2015. Retrieved May 7, 2021.
  25. ^ Seipel, Tracy (March 19, 2015). "California drops hammer on Blue Shield tax-exempt status". San Jose Mercury News. Retrieved March 19, 2015.
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