WellPoint National MCO Analyzer 2011
Analyst: Paula Wade
Report Summary:
WellPoint is now the second-largest insurer by covered lives in the nation, operating Blue Cross Blue Shield plans in 14 states including California and New York. But as 2014 approaches, the company's singular strength in the commercial segment will come under pressure from new medical loss ratio requirements. It's had little success in its stated goals of expanding its reach in the fast-growing segments of Medicaid and Medicare. Two major 2011 acquisitions hint at some new strategies, however: its purchase of vertically integrated Medicare Advantage carrier CareMore Health Plan and its major stake in Bloom Health, operator of a private health exchange system for employer-based plans.
Questions Answered In This Report:
WellPoint is estimated to have to send as much as $280 million in rebates to customers because of federal pricing limits taking effect this year. How is WellPoint changing its plan designs as healthcare reform moves forward? Is WellPoint continuing its practice of allowing each of its state markets to tailor products to their own territories?
Every state and every healthcare market is different, and WellPoint has stayed very attuned to letting each state's Blue plan have control over product and pricing decisions. Where is WellPoint strongest in its control over the market? How is it changing its provider contracting to trim costs ?
WellPoint officials have talked for a long time about seizing opportunities in the Medicaid and Medicare markets, but with limited success. Why hasn't WellPoint joined the rush of national plans into the Medicaid space?
Primary Research:
Analysis of data from HealthLeaders-InterStudy, WellPoint and Centers for Medicare & Medicaid Services
Companies Mentioned In This Report:
- Aetna
- Cigna HealthCare
- Express Scripts
- Health Care Service Corp.
- Monarch Healthcare
- HealthCare Partners
- Resolution Health
- UnitedHealth Group