Blue Cross and Blue Shield of North Carolina reported a dramatic increase in profit in 2016 and paid two top executives bonuses of more than $1 million despite a technology fiasco that triggered complaints from thousands of customers and a record fine from the North Carolina Department of Insurance.
The state’s largest health insurer, which is based in Durham, reported Wednesday that it generated net income of $185 million last year, up from $500,000 in 2015.
This year’s profit amounted to 2.4 cents for every dollar of premium received.
Blue Cross boosted its profitability despite continued losses in insuring people under the Affordable Care Act. It offset those losses with its non-ACA businesses, such as employer-sponsored health coverage and administering the state health plan. Last year’s ACA loss of $38 million was considerably lower than losses of $283 million in 2015 and $123 million in 2014.
Blue Cross CEO Brad Wilson received total compensation of $3.5 million last year, down from $3.8 million in 2015. Last year’s compensation included a bonus of $1.9 million, down from $2.3 million in 2015. Wilson, who has been president and CEO since February 2010, announced last month that he is retiring later this year. He recently turned 64.
Gerald Petkau, the chief operating officer, also received a bonus of a little more than $1 million, down more than $140,000 from his 2015 bonus. Petkau’s total compensation was $1.8 million, down from $1.9 million.
Brendan Riley, a health policy analyst with the N.C. Justice Center, an advocacy group, said he found the bonuses “a little surprising.”
He noted that the insurer’s technology issues created “significant disruptions for consumers and health care providers. ... I’m concerned that they probably led to folks dropping their health insurance coverage, or maybe not getting enrolled in the first place, due to the tech problems.”
But, “things seem to be happening much more smoothly now,” he added. “I do think they deserve some credit for repairing that.”
Mitch Perry, chief financial officer, noted during a conference call that compensation is set by the board of directors and is “consistent with other companies of our nature and our size.”
Bonuses, he said, are based on multi-year periods and “a number of different metrics.”
“I think it’s difficult to look at just one event or one issue or one time period and assess what the compensation should have been,” Perry said. “I would note that, in general, except for the individuals who received promotions during the year, compensation (for top executives) was down about 10 percent on average.”
Blue Cross agreed to a record $3.6 million fine last year after its technology problems caused customers to be double-billed, dropped from coverage or assigned to the wrong health plans. More than 3,000 customers and medical providers complained to the state Department of Insurance.
The problems arose as the company was attempting to move customers’ information to new software. Blue Cross blamed its technology platform, Topaz, and a software program, Facets, for crashing and preventing the transfer of some 400,000 customer accounts.
Blue Cross’s revenue totaled $5.8 billion in 2016, down from $6.5 billion in 2015, as its customer base fell to 3.74 million from 3.89 million previously.
That decline was principally due to the loss of ACA customers, which Perry attributed to non-subsidized customers who balked at higher premiums plus increased competition arising from an uptick in insurers in the ACA marketplace last year.
But two insurers, Aetna and United Healthcare, pulled out of the state’s ACA market at the end of last year. That left Blue Cross as one of just two insurers that offer ACA plans and the only insurer to offer ACA policies in all 100 North Carolina counties.
Perry said that this year Blue Cross has added 200,000 former Aetna and United customers, giving it nearly 500,000 ACA customers.
Blue Cross hasn’t yet decided whether it will continue to offer ACA policies next year.
“We certainly want to be in the market for our customers,” Perry said. “We are working hard to figure out how to be in it, but there is a lot of uncertainty.”
The question marks involve the health needs of the former Aetna and United customers, who are new to Blue Cross, as well as “uncertainty about what may happen in Washington with legislative changes,” Perry said.
President Donald Trump and the Republican-led Congress have talked about repealing and replacing the Affordable Care Act but haven’t formulated a concrete plan to do so.
Blue Cross’s significantly lower ACA losses show that “the market is stabilizing,” Riley said. “They are learning more about how to manage the health care needs and utilizations patterns in the individual markets ... largely those who had pre-existing conditions and could not access health insurance for years.
“I think they deserve credit for sticking it out and providing (ACA) coverage in every county,” Riley said.
Blue Cross, a not-for-profit, annually releases its financial results on the same day it files a detailed annual report with the Department of Insurance. Unlike nonprofits, not-for-profits aren’t exempt from paying taxes. Last year Blue Cross paid $478.1 million in federal, state and local taxes.