BJC Health Pushes Back on Medicaid Managed Care Risk Terms
At a Becker's CEO + CFO Roundtable on Nov. 3, BJC Health's chief managed care officer J.C. McWilliams described the system's shift away from Medicare Advantage downside risk toward direct-to-employer contracting, which has produced a 0.5% combined pharmacy and medical cost trend over three years of renewals. McWilliams also detailed friction in managed Medicaid, where BJC is rejecting standard total-cost-of-care deals, including one plan's proposed two-sided arrangement with a 90% medical loss ratio target against a population running at 99%. Instead, BJC is pushing payers toward narrower arrangements focused only on its highest-risk, highest-cost chronic condition members to limit actuarial exposure. The comments reflect broader health-system wariness of value-based risk terms across MA and Medicaid managed care lines.