Regence BlueCross BlueShield of Oregon retained more than 98% of its employer-sponsored group membership in 2025, the top mark among all 33 Blue Cross Blue Shield plans in what is the most competitive market tier.
The achievement came during a year that Renee Balsiger, vice president of sales at the company, described as the hardest of her nearly four-decade career.
“The market is tough. 2025 was the most challenging I have ever seen,” she told Becker’s. “To be able to renew at the percentage that we did, it was a lot of taking it to the mat.”
Employers are absorbing some of the steepest healthcare cost increases in years. In a recent survey of 27 health plans that cover more than 103 million people, PwC projected a 9% medical cost trend for the group market in 2027, the steepest single-year increase in 17 years. That follows a 2026 total cost increase of 7.9% in the Milliman Medical Index, the sharpest jump in more than a decade outside the pandemic. PwC’s survey attributed the 2027 outlook to provider adoption of AI documentation and coding tools, provider reimbursement pressure and consolidation, pharmacy spending, behavioral health utilization, and out-of-network payment disputes under the No Surprises Act.
The wider industry pressures reshaped how Regence approached renewals, Ms. Balsiger said. With affordability being the top concern for employers, the plan leaned on benefit design changes and other tools to keep accounts, including premium holidays for fully insured groups and virtual-forward products. It also steered members toward expanded primary care access, including through its collaboration with Praxis Health, which opened two advanced primary care clinics for Regence members in West Portland and Eugene last year.
Ms. Balsiger also credited much of the retention to the tenure of the plan’s sales team, which is organized by market segment so that account executives specialize in small group, mid-market or large self-funded accounts.
“They are the front line to our customers, and we have to make sure we surround them with everything they need to service those customers,” she said. “They’re also a very collaborative group. They share best practices: what’s working, what’s not working. That’s super important.”
Even so, she noted that the playbook that’s worked in past years no longer applies.
“The innovation and creativity you have to have in this market is way different than it was even three years ago,” Ms. Balsiger said. “It is not the same game anymore.”
“We’re a market with a lot of competition, and because we are the Blues and we have a lot of business, people were coming after our accounts hard,” she added.
Competition is also intensifying among Blues plans themselves. For the first time, some large national employers can solicit bids from any BCBS plan in the country, not only the one licensed where they are headquartered. Elevance Health, which operates Blues plans in 14 states, offered the first concrete look at the effect, telling investors earlier this year that it bid on 11 national accounts in competing Blues markets in 2025 and won nine. The change stems from a $2.67 billion antitrust settlement that resolved allegations BCBS companies had divided up markets to avoid competing.
Regence is also eyeing an opening closer to home. Providence Health Plan, based in Portland, is winding down most of its insurance business beginning in 2027, ending more than 40 years as a regional payer and affecting about 440,000 members. The plan will exit the ACA market and stop renewing employer group contracts. Ms. Balsiger said brokers are already searching for new insurers for those displaced groups.
“We’re having lots of conversations with our broker partners who are asking how they’re going to take care of their customers,” she said. “So we’re looking to say, let us try to help you create a soft landing there.”
Regence’s Oregon plan covers more than 951,000 members across its employer-sponsored, individual and Medicare businesses.
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