Independence Blue Cross this week began a third wave of personnel cutbacks, with about 200 people expected to lose their jobs in the next several months. This will bring to 855 the number of job losses at the Philadelphia insurer since June. Joseph Frick, Independence Blue Cross' chief executive officer, explained in an annual report distributed to employees that the insurer does not expect to make its annual operating margin goal. Frick blamed many factors contributing to the "unfavorable performance, including higher-than-expected medical costs and a business environment that continues to have an adverse effect on our membership and revenue." Independence Blue Cross had a loss of $78.7 million in 2008, compared with net income of $170.9 million in 2007. Medical membership dropped to 3.3 million as of Sept. 30, compared with 3.4 million last December.