WellCare | National MCO Analyzer | 2011

Analyst: Taylor Holliday

Report Summary
WellCare is finally emerging from the long legal aftermath of the 2007 federal raid and investigations for Medicaid fraud, having paid out multi-million-dollar settlements to the government and to whistleblowers. It's hoping for a financial turnaround in 2011, with a new Medicaid contract in Kentucky to add to its stable of business. WellCare is focused solely on Medicaid and Medicare, both Part D and Medicare Advantage. But its two largest Medicaid contracts, in Georgia and Florida, are up for bids in 2012, putting a huge portion of WellCare's revenues at risk. 

Questions Answered In This Report
WellCare has survived its legal troubles and emerges in a much more competitive Medicaid MCO market, with more multi-line carriers vying for state contracts. Where is WellCare likely to be at risk of losing some or all of its Medicaid membership? What is its strategy for meeting states' demands for greater management of members' health conditions?

WellCare has not fared so well in the Medicare Advantage market, where it markets actively in 12 states. What has WellCare done to help shore up its MA enrollment since having to exit the private fee-for-service business in 2009? Will it pursue Medicaid contracts in its MA states?

WellCare is a relatively small player in the Part D, but the segment is a solid contributor to the bottom line. How are the three segments of WellCare's business faring? What is its strategy for growth in the consolidating Part D business?

Primary Research
Documents and data research from HealthLeaders-InterStudy, CitiGroup World Markets, WellCare, Centers for Medicare & Medicaid Services