Overview
Blue Cross and Blue Shield of Kansas City (Blue KC) announced an affiliation agreement with Highmark last week, marking the latest, though almost certainly not the last, in a series of high-profile regional not-for-profit health plans consolidating, affiliating, or shutting down.
Adam Fein of Drug Channels coined a useful term, the retail pharmacy shakeout, to describe the market dynamics that led to rightsizing by CVS and Walgreens, bankruptcy for Rite Aid, and the shuttering of scores of small and independent pharmacies.
A similar dynamic is emerging in the health plan market. This past September, before the Blue KC affiliation and the announcement from Minnesota’s UCare that it was closing its doors, HealthScape Advisors published an executive briefing titled “Unsustainable? Regional not-for-profit health plans face tough choices over next 2 years,” which featured this striking graph of operating margins by plan type:
Members can see our Not-For-Profit shakeout tracker and read our thoughts on what this will mean in 2026 below:
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