In­surer prof­its through the roof

Modern Healthcare - - Front Page -

Act re­quires in­sur­ers, be­gin­ning this year, to spend 80% to 85% of mem­ber pre­mium dol­lars on di­rect med­i­cal care and qual­ity im­prove­ment ac­tiv­i­ties.

Start­ing in 2012, in­sur­ers must give mem­bers re­bates for the dif­fer­ence if they do not meet these med­i­cal-loss ra­tios. In­sur­ers re­ported ra­tios at or within reach of the fed­eral re­quire­ments, and said they do not ex­pect the re­bates to sig­nif­i­cantly af­fect their bot­tom lines.

For in­stance, Michael Wieder­horn, an­a­lyst at Op­pen­heimer, wrote in an in­vestor note that al­though def­i­ni­tions on the re­bates are still be­ing eval­u­ated, “we be­lieve the im­pact will be neg­li­gi­ble” for Aetna.

Some in­sur­ers re­ported en­roll­ment growth among young adults, spurred by a pro­vi­sion in the fed­eral re­form law re­quir­ing em­ploy­ers to al­low young adults up to age 26 to be added to their par­ents’ health plans. The pro­vi­sion went into ef­fect Sept. 23, 2010, though most em­ploy­ers did not have to add the new de­pen­dents to their rolls un­til Jan­uary. Wel­lPoint re­ported that the pro­vi­sion added nearly 292,000 new mem­bers in the first quar­ter, to a to­tal of nearly 34.2 mil­lion mem­bers na­tion­wide.

Wel­lPoint and Aetna also touted their ac­count­able care or­ga­ni­za­tion pilot pro­grams, and ex­pressed a com­mit­ment to ex­pand­ing these new re­la­tion­ships with providers. Aetna, which in March an­nounced an ACO ini­tia­tive with the Car­il­ion Clinic in Roanoke, Va., is “de­ter­mined to be a leader” in this area, Mark Ber­tolini, chair­man, CEO and pres­i­dent of Aetna, said dur­ing an in­vestor call. 1st quar­ter net earn­ings


mil­lion % in­crease over a year ago

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