Humana National MCO Analyzer - 2011

Analyst: Paula Wade

Report Summary
Humana Inc. is betting heavily on its ability to deliver low-cost Medicare Advantage and stand-alone Part D products, partnering with retail giant Wal-Mart Stores and blanketing the country with Medicare Advantage options. Because of the growth in its Part D products, Humana's in-house PBM is carrying much more clout in the marketplace, and may use it to further its aims for re-building its shrinking commercial business.

Questions Answered in this Report

Humana's partnership with Wal-Mart Stores is viewed as a game-changer for the Medicare Part D stand-alone market. What are some of the risks in its low-price strategy, and how have others reacted? Will Humana also market commercial products in Walmart kiosks?
Humana's commercial membership has been shrinking gradually, and its commercial medical loss ratios signal that it may have substantial rebates to pay to customers at year-end. Where is Humana still a player in the commercial space?
As federal reimbursement rates for Medicare Advantage fall, health plans will depend on the revenue from "star quality" bonuses to make their margins, and keep products robust and prices low. Where is Humana in the star quality universe, and in what areas is it likely to be aiming for quality improvements?

Markets Covered
United States and Puerto Rico

Primary Research
Data from HealthLeaders-InterStudy, Centers for Medicare & Medicaid Services, Humana, SEC filings

Selected Companies Listed in the Report
• Availity
• Concentra
• CIGNA HealthCare
• Humana Inc.
• Wal-Mart Stores