Strong well-entrenched competitive position in western and central Pennsylvania. Very strong balance sheet characteristics based on key credit metrics. Very strong liquidity. Improved operating performance in 2010. Successful diversification into specialty products, such as dental insurance, vision care, and stop-loss insurance. Geographic concentration in a market with limited organic growth opportunities. Unprofitability of Direct Pay health insurance operating unit. Slightly unfavorable regulations. Status as insurer of last resort in western and central Pennsylvania. The financial strength rating on Highmark Inc. (d/b/a Highmark BlueCross BlueShield) is based on the company's strong competitive position in its core markets, very strong balance sheet characteristics, very strong liquidity, improved operating performance in 2010, and good business and earnings diversity through the specialty products unit.