Never-Event Payment Policies - How Health Plans Are Getting Tough on Preventable Hospital Errors; Implementing 'Medical Homes' to Improve Patient Care and the Bottom Line


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Reprinted from HEALTH PLAN WEEK (formerly Managed Care Week), the industry's leading source of business, financial and regulatory news of health plans, PPOs, and POS plans.

Charts on this Page:

Fourth-Quarter 2007 Financial Results of Publicly Traded Managed Care Companies (for the period that ended Dec. 31, 2007)
Net Income (Loss)
for Fourth-Quarter
Fourth-Quarter Income (Loss) per Diluted Share for Medical Enrollment on Dec. 31, Fourth-Quarter Medical-Cost
Ratio for
Fourth-Quarter Administrative-Cost Ratio for
2007 2006 2007 2006 2007 2006 2007 2006 2007 2006
Aetna, Inc. $448.4 million $434.1 million $0.87 $0.80 16.8 million 15.4 million 79.2%1 79.8%1 19.0% 19.4%
AMERIGROUP Corp. $31.1 million $29.9 million $0.57 $0.56 1.7 million 1.3 million 82.9% 80.4% 13.1% 14.2%
Assurant, Inc. $120.8 million2 $252.5 million2 $1.01 $2.01 871,000 935,000 62.0%3 63.3%3 29.5%3 30.3%3
Centene Corp. $14.7 million $13.8 million $0.03 $0.31 1.4 million 1.3 million 84.0% 82.1% 14.3% 12.8%
CIGNA Corp. $263 million $232 million $0.93 $0.76 10.1 million 9.4 million 84.6%4 83.9%4 27.3%5 26.3%5
Coventry Health Care, Inc. $184.3 million $156.1 million $1.18 $0.97 4.0 million 2.5 million 78.1%6 78.3%6 18.1% 13.0%
HealthSpring, Inc. $26.2 million $20.1 million $0.46 $0.35 153,1977 143,000 78.1%8 79.6%8 11.7% 14.5%
Health Net, Inc. $123.4 million $84.8 million8 $1.10 $0.76 6.6 million 6.3 million 82.6%9 82.9%9 10.5% 13.3%
Humana Inc. $243.3 million $155.0 million $1.43 $0.92 7.9 million 7.7 million 80.3% 83.2% 16.0% 14.7%
Molina Healthcare, Inc. $17.9 million $10.7 million $0.63 $0.38 1.1 million 1.1 million 83.6% 85.1% 11.8% 11.1%
UnitedHealth Group $1.2 billion $1.1 billion $0.92 $0.84 27.9 million 28.6 million 79.9%10 80.0%10 14.4% 15.0%
WellPoint, Inc. $859.1 million $801.1 million $1.51 $1.28 34.8 million 34.1 million 82.9% 81.0% 13.8% 15.7%
1 Ratio is for all medical and dental risk products.
2 Includes $27 million of after-tax realized losses from other than temporary impairments in the investment portfolio. Includes a $63.9 million after-tax gain from the sale of Private Healthcare Systems, Inc. and $40.5 million of after-tax income from a legal settlement.
3 Ratios are for Assurant Health only.
4 Ratios are for commercial risk products, excluding voluntary/limited benefit business.
5 Ratios are for CIGNA HealthCare business unit.

6 Ratios are for health plan business only.
7 HealthSpring acquired Leon Medical Centers Health Plans on Oct. 1, 2007. As of the acquisition date, the health plan had approximately 25,800 members
.
8 Ratio is for Medicare products only
9 Ratios exclude TRICARE enrollment
10 Ratio is for all risk-based business and products
NOTE: WellCare Health Plans, Inc. was omitted from this table because it has delayed reporting full financial and operating data for the fourth quarter of 2007 in light of an ongoing investigation by federal and state agencies. Sierra Health Services, Inc.’s fourth-quarter 2007 financial data had not been released as of HPW’s press time. Sierra’s acquisition by UnitedHealth Group was approved on Feb. 25. SOURCE: Compiled by Atlantic Information Services, Inc. from company financial reports.

Third-Quarter 2007 Financial Results of Publicly Traded Managed Care Companies (for the period that ended Sept. 30, 2007)
 
Net Income (Loss) for Third-Quarter 
 Third-Quarter Income (Loss) per Diluted Share for
Medical Enrollment on Sept 30,
Third-Quarter Medical-Cost Ratio for
Third-Quarter Administrative- Cost Ratio for
2007
2006
2007
2006
2007
2006
2007
2006
2007
2006

Aetna, Inc.

$496.7 million

$476.4 million

$0.95

$0.85

16.6 million

15.4 million

79.4%

78.8%

18.2%

18.4%

AMERIGROUP Corp.

$31.2 million

$24.6 million

$0.58

$0.46

1.5 million

1.2 million

82.9%

81.7%

12.6%

13.0%

Assurant, Inc.

$187.2 million

$151.3 million

$1.56

$1.18

910,000

954,000

63.5%1

62.4%1

29.3%1

29.1%1

Centene Corp.

$15.9 million

($71.2 million)2

$0.36

($1.65)2

1.1 million

1.2 million

81.5%

84.4%

11.0%

10.4%

CIGNA Corp.

$365 million

$298 million

$1.28

$0.92

10.2 million

9.3 million

83.0%3

85.6%3

27.2%4

27.1%4

Coventry Health Care, Inc.

$168.7 million

$147.5 million

$1.08

$0.92

3.9 million

3.4 million

79.0%

78.6%

18.7%

16.9%

HealthSpring, Inc.

$22.4 million

$31.1 million

$0.39

$0.54

139,000

148,000

81.8%5

75.7%5

11.0%

11.0%

Health Net, Inc.

($103.8 million)6

$90.9 million

($0.93)6

$0.76

6.3 million

6.3 million

89.8%7

82.9%7

18.6%

13.3%

Humana Inc.

$302.4 million

$159.2 million

$1.78

$0.95

7.9 million

7.9 million

81.3%

84.1%

13.3%

13.1%

Molina Healthcare, Inc.

$17.5 million

$12.3 million

$0.62

$0.44

1.0 million

1.0 million

83.7%

84.1%

11.7%

11.7%

Sierra Health Services, Inc.

$34.6 million

$34.9 million

$0.59

$0.56

877,000

839,000

81.7%

77.3%

9.5%

12.6%

UnitedHealth Group

$1.3 billion

$1.1 billion

$0.95

$0.80

28.6 million

28.3 million

79.5%

81.1%

14.0%

13.5%

WellPoint, Inc.

$868.0 million

$810.8 million

$1.45

$1.29

34.8 million

34.2 million

81.8%

81.3%

14.6%

15.5%

1 Ratios are for Assurant Health only.
2 Third-quarter 2006 figures include a one-time charge of $87.1 million related to the loss of Centene's Kansas Medicaid contract.
3 Ratios are for commercial risk products, excluding voluntary/limited benefit business.
4 Ratios are for CIGNA HealthCare business unit.
5 Ratio is for Medicare products only.
6 Third-quarter 2007 figures include a one-time charge of $296.8 million related to the settlement of class-action litigation, regulatory matters and other legal expenses. The charge also drove up Health Net's medical cost ratio for the most recent period.
7 Ratios exclude TRICARE enrollment.
NOTE: WellCare Health Plans, Inc. was omitted from this table because it has delayed reporting full financial and operating data for the third quarter of 2007 in light of an ongoing investigation by federal and state agencies.
SOURCE: Compiled by Atlantic Information Services, Inc. from company financial reports.

Second-Quarter 2007 Financial Results of Publicly Traded Managed Care Companies
(for the period that ended June 30, 2007)

 

Net Income (Loss) for Second-Quarter

Second-Quarter Income (Loss) per Diluted Share for

Medical Enrollment on June 30,

Second-Quarter Medical-Cost Ratio for

Second-Quarter Administrative- Cost Ratio for

2007

2006

2007

2006

2007

2006

2007

2006

2007

2006

Aetna, Inc.

$451.3 million

$389.5 million

$0.85

$0.67

15.8 million

15.4 million

81.5%

81.9%

17.8%

18.4%

AMERIGROUP Corp.

$32.8 million

$15.3 million

$0.61

$0.29

1.5 million

1.2 million

83.1%

83.4%

12.1%

13.0%

Assurant, Inc.

$166.3 million

$151.1 million

$1.36

$1.16

930,000

963,000

64.1% 1

61.8% 1

30.3% 1

30.8% 1

Centene Corp.

$17.8 million 2

$5.0 million

$0.40 2

$0.11

1.1 million

1.1 million

80.6% 3

84.0% 3

14.0% 3

12.3% 3

CIGNA Corp.

$198 million 4

$273 million

$0.684

$0.78

9.8 million

9.0 million

84.7% 5

85.0% 5

25.7% 6

27.0% 6

Coventry Health Care, Inc.

$151.3 million

$135.5 million

$0.96

$0.84

3.4 million

3.4 million

79.6%

80.0%

19.0%

17.1%

HealthSpring, Inc.

$16.2 million 7

$21.1 million

$0.28 7

$0.37

140,000

146,000

81.0% 8

79.5% 8

11.9%

11.1%

Health Net, Inc.

$92.0 million

$77.0 million

$0.80

$0.65

6.6 million

6.6 million

84.7% 9

84.0% 9

12.5%

13.5%

Humana Inc.

$216.8 million

$89.5 million

$1.28

$0.53

7.8 million

7.6 million

83.4%

85.1%

13.0%

13.7%

Molina Healthcare, Inc.

$13.3 million

$13.2 million

$0.47

$0.47

1.1 million

1.1 million

85.1%

83.7%

10.9%

11.6%

Sierra Health Services, Inc.

$39.4 million

$33.5 million

$0.67

$0.54

866,000

824,000

76.8%

77.8%

13.0%

12.6%

UnitedHealth Group

$1.2 billion

$981 million

$0.89

$0.70

28.7 million

28.4 million

80.5%

81.6%

13.8%

13.9%

WellCare Health Plans, Inc.

$54.6 million

$22.2 million

$1.30

$0.55

1.3 million

1.1 million

82.0%

82.4%

12.0%

12.3%

WellPoint, Inc.

$835.2 million

$751.2 million

$1.35

$1.17

34.8 million

34.2 million

81.8%

81.2%

15.1%

15.7%

1 Ratios are for Assurant Health only.
2 Second-quarter 200