While continuing to carry out an all-hands-on-deck public vaccination effort in response to the COVID-19 pandemic, we also made tremendous progress in expanding and improving care delivery in western Pennsylvania. Most notably, we opened AHN Wexford Hospital, a state-of-the-art facility made possible by a $1.5 billion investment we announced in 2017. Other highlights included: opening the AHN Cancer Institute Clinical Genomics Laboratory, bringing new capabilities to the region for developing and providing targeted cancer drug therapies; completing the first AHN and Johns Hopkins collaborative lung transplant and AHN's first living donor liver transplant; and breaking ground on a new AHN Health + Wellness Pavilion.

Financial and Operational Resilience
This report's financial performance presentation and financial overview demonstrate our continued resilience and strength. That strength enabled us to invest nearly $1.4 billion to support customers, providers, and communities since the start of the pandemic, while also making capital investments of more than $750 million in 2021 to advance our mission of creating a remarkable health experience, freeing people to be their best.

Highmark Health's consolidated operating revenue for the year, $22 billion, represents a 22% increase from 2020. Highmark Health Plans had another strong year, with an operating margin of more than $300 million. Highmark grew its commercial business as a result of an exceptional 98% retention rate as well as the acquisition of new membership through the completion of the HealthNow affiliation. Highmark remains the commercial market leader across nearly all areas served, and core health plan membership increased to approximately 6.8 million members.

Allegheny Health Network realized earnings of $154 million before interest, taxes, depreciation, and amortization, a year-over-year improvement of more than $70 million. Operating revenue reached $4 billion, an improvement of $375 million. Driving those numbers, patient volumes returned to near pre-pandemic levels. In fact, in the first nine months of 2021, observation cases, outpatient registrations, surgical volumes, emergency department visits, and physician visits all saw double-digit percentage increases year over year. At the same time, like provider systems across the country, AHN continues to face cost pressures related to nursing shortages, supply chain concerns, and the cost of personal protective equipment. We have implemented comprehensive, organization-wide strategies to address these pressures.

Diversified businesses remain vital to Highmark Health's financial strength, contributing combined operating earnings of more than $250 million in 2021. In addition to solid performance from HM Health Solutions, HM Insurance Group, United Concordia Dental, and Helion, we launched a new business in 2021, Lumevity. An outgrowth of an internal transformation program that has had $500 million of direct bottom-line impact over three years at Highmark Health, Lumevity helps other companies transform to drive direct financial benefits while improving quality and increasing employee engagement.

Stepping Up, Stepping Forward
Although COVID-19 pandemic challenges persisted in 2021, we are extremely proud of how our 37,000 employees remained resilient, worked together to overcome every obstacle for the communities we serve, and advanced our strategy. As we move toward a post-pandemic future, we are confident that their efforts will continue to drive innovation and growth, fulfilling our commitment to strengthening communities and to the vision of a world where everyone embraces health.