Download the 2010 OC HMOs List (pdf)
Orange County’s largest health maintenance organizations held steady during the past year.
The eight HMOs on this year’s Business Journal list reported a less than 1% drop in local members to 1.23 million.
A sluggish economy, coupled with continuing lags in employment, likely tamped down growth among health plans.
The Business Journal ranks its list by local enrollment, with figures compiled from the companies themselves.
None of the plans changed their ranks from a year ago, and no plan posted double-digit membership gains or losses.
One plan added members, three lost them, two were roughly flat at less than 1% changes and two were Business Journal estimates.
In this slow-growth year for HMOs, Kaiser Permanente, an Oakland-based plan, continued its reign as OC’s No. 1 HMO with a small uptick.
Kaiser reported 403,000 enrollees in the county, 3% higher than a year ago.
The plan’s enrollment has more than doubled since the early 1990s. Kaiser, which also owns hospitals and has an affiliated medical group, has expanded its local presence.
The healthcare provider is working on a $560 million hospital in Anaheim that will have 10 operating rooms and replace its aging facility on Lakeview Avenue. It also has a large hospital on Sand Canyon Avenue in Irvine.
Figures for Anthem Blue Cross, the No. 2 plan, are Business Journal estimates. We estimate that Anthem Blue Cross has 290,000 members in the county.
No. 3 UnitedHealthcare/PacifiCare said it had 179,400 members in OC, down 600 members, or 0.3%, from a year ago.
A UnitedHealthcare spokeswoman said that the slight dip could be attribut- ed to some movement from HMOs to preferred provider organization plans.
Health Net Inc. of Woodland Hills repeated as No. 4 on the list, although its OC membership of 144,000 was down 4%, or 6,000 people, from a year ago.
San Francisco-based Blue Shield of California was the No. 5 plan on the list with a slight gain to 108,628 members from 107,943.
Blue Shield was followed by Aetna Health of California, which reported a 7% enrollment drop, or about 4,800 local members, to 62,436. Aetna was No. 6 on the list.
Aetna said in an e-mail that the slow economy had caused many of its employ- er clients to shift from HMOs to lower-priced plans that have higher deducti- bles and out-of-pocket costs for their workers.
Cigna Healthcare, a unit of Philadel-phia’s Cigna Corp., is the No. 7 entry on the list with 25,282 local members.
The list is closed out by Scan Health Plan, a Medicare HMO that’s just over the county line in Long Beach. Scan’s local membership fell 2%, or about 340 people, to 19,002.
PPO Directory
Six preferred provider organizations reported OC enrollment figures to the Business Journal.
Five other companies on the directory didn’t provide local enrollment numbers. Together, their enrollments fell 5% to 1.6 million members during the past year.
PPOs’ main difference from HMOs is that they allow patients more freedom in their healthcare decisions, albeit at a higher cost.
They gained some popularity at the expense of HMOs in the past 15 years or so, particularly during the late 1990s and early 2000s, when competition for workers was more intense and employers were more inclined to use benefits as hiring lures.
Today, some observers believe PPOs’ appeal may have moderated because of economic fluctuations and a bit of leeway among HMOs in allowing access to specialist doctors.
UnitedHealthcare/PacifiCare was the only PPO that had a double-digit membership gain over the previous year, growing 10.5% to 42,000 enrollees, partially because of the aforementioned movement by some of its clients who previously had HMO plans.
Aetna Health of California said its local PPO membership fell 6% to 120,497 enrollees.
Blue Shield of California’s Orange County PPO membership grew 4% to 135,357 members from 130,578.
Cigna Healthcare reported 10,683 PPO members. Last year, the figure of 10,700 OC members for Cigna was an estimate.
Another PPO that saw its numbers drop slightly was Health Net Life Insurance Co., which had a 4% decline, or 1,000 members, to 22,000 members.
MultiPlan Inc., a New York-based PPO, reported having 66,800 enrollees in OC. Last year, MultiPlan said it had 107,000 enrollees, a 38% drop.
MultiPlan is being acquired by a pair of private equity investors: BC Partners of New York and Silver Lake of Menlo Park. Earlier this year, MultiPlan bought Illinois’ Viant Holdings Inc., whose business units include Beech Street Corp. of Lake Forest.
Beech Street has an estimated 155,000 local members. The company, which was established nearly 60 years ago and put its first preferred provider network together in 1984, is considered a formative player in the PPO movement.
Interplan Health Group, which is based in Farmington, Conn., is the largest PPO by membership on the directory. The Business Journal estimates it has 575,000 local members.
We estimated that Private Healthcare Services, owned by Private Healthcare Systems Inc. of Waltham, Mass., has 130,000 local members.
For First Health, a San Diego PPO, we estimate that it has 34,000 members in OC. n
