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Larson concurs.

"Having an in-plant on site just lowers prices," she says. "And we can customize the work to suit our customers' needs much more easily than a commercial printer can."

The value of BCBS in-plants even holds up under scrutiny.

"In Michigan, they've brought in consultants on two occasions to look at the possibility of outsourcing us," says Patrick O'Donnell, manager of BCBS of Michigan Printing Services. "Both times, the consultants have told the company that we should be doing more printing work."