Health maintenance organizations in Orange County saw a year of little growth.
The eight HMOs on this year’s Business Journal list combined for a total of 1,130,344 members as of July, up just 0.27% from last year’s 1,127,275 members.
The Business Journal ranks health maintenance organizations by local membership numbers.
Two plans said they had more members, while two others had declines. Four were flat, according to Business Journal estimates.
Perennial leader Kaiser Permanente topped the list again.
Oakland-based Kaiser reported 455,561 enrollees in Orange County, up 5% from a year ago.
Kaiser’s HMO membership growth has led the organization to open a $425 million hospital in Anaheim on La Palma Avenue that will open on Sept. 12. Kaiser’s new hospital is the centerpiece of a $650 million campus that also features two medical office buildings, a support facility and a parking structure with more than 1,500 spaces.
The new hospital will open with six floors and 262 beds, doubling Kaiser’s total at its current Anaheim hospital on Lakeview Avenue. The hospital has 17 operating rooms, 36 emergency room bays, 24 pediatric beds and 20 neonatal intensive care bassinet rooms, and its special features include new touch-screen technologies and a central utility plant.
Most of Kaiser’s members reside in North and Central Orange County, Julie Miller-Phipps, vice president and executive director of Orange County operations, said in an earlier interview.
Kaiser also owns a hospital in Irvine and has an affiliated medical group.
Anthem Blue Cross, a unit of Indianapolis-based WellPoint Inc., continued as the No. 2 HMO in Orange County with an estimated 290,000 local enrollees.
Woodland Hills-based Health Net Inc. rose to No. 3 on the list—though its membership dropped 14% to 121,000.
Health Net is still seeing membership losses in its large groups because of economic uncertainty, said Brad Kieffer, a company spokesperson. Health Net is working to reverse the trend through introducing plans with smaller, tailored provider networks that give opportunities for double-digit premium savings, Kieffer said.
The list’s No. 4 plan, Blue Shield of California, reported having 106,720 members.
San Francisco-based Blue Shield found itself in the middle of a contract dispute in late 2011 with Irvine-based Monarch HealthCare, A Medical Group Inc.
Blue Shield and Monarch went at it through newspaper advertisements and other forums, and in February the health insurer said it was suing Monarch.
Blue Shield alleged Monarch refused to treat its members and “committed multiple breaches of contract” while under a three-year provider contract that took effect in January 2010. Blue Shield is seeking damages of $10.5 million in the complaint.
Blue Shield said the 2011 sale of Monarch’s management arm to Optum—a unit of Minnesota-based UnitedHealth Group Inc., which operates UnitedHealthcare, the list’s No. 6 plan—was made without its consent. It said Monarch afterward solicited Blue Shield members to join other healthcare plans while refusing to treat some Blue Shield enrollees.
The insurer eventually told Monarch it was terminating its commercial and Medicare HMO contracts effective May of this year.
Monarch answered back, calling Blue Shield’s allegations into question.
“We object to the mischaracterizations made by Blue Shield,” said Bart Asner, the medical group’s chief executive.
Monarch considers it “our responsibility to always act in the best interest of patients,” Asner added.
Up 2%
Blue Shield was followed by No. 5 Aetna Health of California. Aetna reported 57,654 members in Orange County, up 2% from a year ago.
UnitedHealthcare came in at No. 6 on the list, reporting 53,100 local members, unchanged from last year’s estimate.
The Business Journal estimated Cigna Healthcare, which is the No. 7 plan on the list, had 28,447 local members.
Scan Health Plan, a Long Beach-based HMO that caters to senior citizens, rounds out the list. Scan reported having 17,862 members in the county, down 2% from a year ago.
Preferred provider organizations listed in the Business Journal’s unranked directory (see page 20) combined for a 4% enrollment increase to 922,803 local members.
Six of the PPOs listed provided enrollment figures to the Business Journal.
Information on the other three plans is based on Business Journal estimates.
PPOs tend to be more expensive for patients than HMOs but allow patients more options and flexibility in obtaining healthcare services. They have gained enrollment at the expense of HMOs in recent decades, especially when the economy was stronger, competition for workers was more intense, and employers were more inclined to use benefits as hiring lures.
The Business Journal estimates that the largest area PPO is Anthem Blue Cross, with 290,000 local members.
Other large PPOs include Aetna Health of California, with 132,015 local members.
