Health maintenance organizations grew at a steady pace over the past year in Orange County.
The eight HMOs on the Business Journal’s annual list combined for 1,233,377 local members, a 6.5% increase from last year’s 1,157,850.
The list ranks HMOs by local membership numbers.
Three plans said they increased membership, while one plan’s numbers declined. Four are Business Journal estimates.
n Kaiser Permanente continued its long run at the top of the county’s HMO pack.
The Oakland-based company said it had 470,000 enrollees in Orange County, up 3% from a year ago.
Kaiser’s been on a growth spurt in recent years—it’s about to mark the first anniversary of its $425 million hospital on La Palma Avenue in Anaheim that it opened to serve the majority of its membership, which resides in North and Central Orange County.
n Anthem Blue Cross, a unit of Indianapolis-based WellPoint Inc., came in at No. 2 with an estimated 290,000 enrollees.
n San Francisco-based Blue Shield of California came in at No. 3 with an estimated 170,000 Orange County members.
Blue Shield announced in February that it and Irvine-based medical group Monarch HealthCare resolved their legal dispute.
“Monarch HealthCare acknowledges that it took actions in 2011 and 2013 that were not consistent with its commitments under the contract it had with Blue Shield of California,” the insurer said in a press release. “Monarch HealthCare values its relationships and regrets any harm that may have resulted from its actions.”
Blue Shield found itself in the middle of a contract dispute with Monarch at the end of 2011. The entities went at it through newspaper advertisements and other means and eventually took legal actions against each other before settling.
n Health Net Inc., which is based in Woodland Hills, fell to No. 4. The insurer said it had 111,000 members in OC, down 8% from a year ago.
Health Net was engulfed in a contract dispute at the end of 2012 that likely affected its OC membership. It ended contracts with Fountain Valley Regional Hospital and Medical Center; Los Alamitos Medical Center; Placentia-Linda Hospital; and three others owned by Dallas-based Tenet Healthcare Corp.
Health Net officials said at the time that they felt they had no choice but to end the contract.
“Tenet Healthcare has refused our requests to negotiate a new contract that more accurately reflects current statewide market conditions,” Health Net said.
Tenet responded that it had been negotiating with Health Net and that “it is unclear to us as to why Health Net issued a contract termination and publicly released inaccurate information.”
Within a month, Health Net said it signed new two-year deals with Fountain Valley, Los Alamitos, and Placentia-Linda and several other Tenet California hospitals. Health Net said in a news release that the contracts were reinstated and retroactively covered the Tenet hospitals “as if there was no termination.”
n United Healthcare Services Inc. and Aetna Health of California followed at Nos. 5 and 6, respectively.
United Healthcare reported having 95,351 members in the county, up slightly from an estimated 94,000 members in the period ended July 2012.
Aetna reported having 60,582 HMO members in Orange County, up 5% from a year ago.
Aetna and United both announced this summer that they would quit selling individual health plans at the end of the year (see story, page 24).
The carriers emphasized their decisions were related to business conditions and not to the pending introduction of Covered California, the state’s health insurance exchange designed to provide coverage to the some 7.1 million state residents who are uninsured.
n Scan Health Plan, a Long Beach-based company, came in at No. 7. Scan, which primarily serves Medicare beneficiaries, reported a 20% gain in membership to 21,391.
It attributed the increase to “competitive benefits in our existing products,” as well as new products “designed to meet the specific needs of people with diabetes and heart disease. Enrollment exceeded our expectations in both products,” said Sherry Stanislaw, a Scan senior vice president.
n Cigna Healthcare, a unit of Philadelphia-based Cigna Corp., rounded out the list, reporting having 15,053 HMO members in Orange County.
Preferred provider organizations in the Business Journal’s unranked directory combined for a 2.4% membership increase to 738,813.
Five of the PPOs provided enrollment figures to the Business Journal. Information on the other four plans comes from Business Journal estimates.
PPOs are usually more expensive for patients than HMOs are, but PPOs allow patients more options and flexibility in obtaining healthcare services.
PPOs have gained enrollment in recent years at the expense of HMOs, particularly when the economy was strong, competition for employees was more intense, and businesses were more inclined to use employee benefits as hiring lures.
UnitedHealthcare said it had 127,300 members in OC, up 7% from last year’s 118,700.
Cigna Healthcare said its local PPO membership totaled 63,535.
The Business Journal estimates that Anthem Blue Cross’ membership was 290,000, making it the largest PPO in the directory.
Another six-figure estimate includes Blue Shield, with 129,928.
