Aetna
Analyst: Paula Wade
Report Summary
With 17.6 million members nationwide, Aetna is the nation's third-largest health carrier behind UnitedHealth Group and WellPoint Inc. But Aetna does not dominate any large local markets, and is working to become a player in the fast-growing Medicaid segment, which is set to expand by at least 16 million covered lives beginning in 2014. In 2011, Aetna has done a massive transformation of its plan designs, moving to high-deductible plans and heavy cost-sharing designs that incentivize in-network utilization. It is moving toward creation of commercial accountable care organizations by contracting with key providers rather than buying them outright.
Questions Answered In This Report
In many markets, Aetna leads the second-tier health plans after UnitedHealth and the local Blue Cross Blue Shield entities, but even in its best market still ranks no higher No. 3. How are its commercial products changing? Where are Aetna's key commercial markets, and how are they moving to expand their reach?
Aetna made three major acquisitions in 2011: the large third party administrator Prodigy Health, the technology firm Medicity, and the account-based plan administrator, PayFlex Holdings. What are Aetna's plans for these large purchases? How many lives does Prodigy add?
Aetna suffered in the Medicare Advantage space because federal sanctions kept it from marketing for the 2011 plan year. It's still only a small player in Medicaid, despite its huge planned expansion. What will Aetna do to get back into the MA game? Is its acquisition of the Medicare supplement lives from Genworth Financial signalling that it intends to focus on supplement products? On the Medicaid side, where is Aetna likely to try to expand?
Primary Research
Interviews with Aetna officials, documents and research and data from HealthLeaders-InterStudy, Aetna, the Centers for Medicaid & Medicare Services, CitiGroup Global Markets
Companies Mentioned in This Report
- Aetna
- Carilion Clinic
- CVS Caremark
- Genworth Financial
- Prodigy
- UnitedHealth Group
- WellPoint Inc.