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Friday, Jun 9, 2023

Orange County’s HMOs Grow Enrollment 0.5% While PPOs Dip

Orange County’s largest health maintenance organizations, or HMOs, grew last year while their counterparts, the primary provider organizations, or PPOs, saw a slight dip.

The five firms on the Business Journal’s annual list saw a 0.5% increase to 761,167 enrollees in HMOs as of July while the PPO enrollees dipped 0.3% to 191,364.

Companies are unranked and listed alphabetically; several providers dropped off the list after declining to provide information specific to OC.

The largest provider of HMOs continues to be Oakland-based Kaiser Permanente, which reported a 0.5% increase to 583,000.

It’s also Orange County’s third largest hospital system. Kaiser doesn’t provide PPO services.

SCAN Health Plan, a Medicare Advantage insurance provider for the senior market based in Long Beach, led the growth with a 6.1% rise to 43,966 in HMO enrollees. That follows a 12% rise a year ago.

Growth outside Orange County for SCAN was slower as companywide, its HMO enrollees rose 0.8% to 220,455. It also doesn’t provide PPO plans.

The SCAN Health Plan is one of the nation’s largest not-for-profit Medicare Advantage plans, serving more than 220,000 members in California. Since its founding in 1977, SCAN says it’s “a mission-driven organization” dedicated to keeping seniors healthy and independent.

A year ago, Bloomfield, Conn.-based Cigna (NYSE: CI), expanded its digital services for its Medicare Advantage and individual and family plan members.

Cigna Healthcare of Irvine saw a 3.7% drop to 44,201 members in HMOs while its PPOs also fell, 0.9% to 74,364. The number of its physicians agreeing to HMO contracts rose 4.4% to 8,503.

Overall, the number of physicians working under an HMO contract increased 1.9% to 20,502 while those on PPO contracts were flat at 23,990.

The HMO firms reported companywide enrollees were slightly down. 0.1%, to 15.7 million members while the PPO enrollment companywide was flat at 19.7 million.

The firms reported 0.3% decline in PPO enrollees to 191,364 in Orange County. This marks the second straight decline, as last year they fell about 0.1%.

Virtual Treatment

HMOs and PPOs have rapidly expanded services in virtual settings, preventing deferred treatment and enabling more comprehensive care in areas such as mental and behavioral health, oftentimes relying on connectivity and monitoring devices to do so.

Huntington Beach-based Health Net LLC is trying to help provide accurate population health data, which is necessary to improve access and quality of care for the state’s Medi-Cal population, Health Net CEO Brian Ternan said in a March press release.

Health Net has an estimated Orange County base of 90,000 enrollees in its HMO plans and 16,000 in its PPO plans. Companywide, it has an estimated 2.7 million HMO enrollees and 120,000 PPO enrollees.

Health Net in March announced a $26 million investment to improve the collection of patient encounter data to better understand how vulnerable communities are accessing care statewide.

The investment is part of Health Net’s $50 million commitment to its Encounter Data Improvement Program (EDIP). In partnership with the Department of Managed Health Care, the program aims to improve the collection of accurate and timely encounter data while reducing the barriers to what Health Net describes as a “historically fragmented and inconsistent” data collection system. EDIP is initially focusing on Medi-Cal providers.

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Peter J. Brennan
Peter J. Brennan
Peter J. Brennan has been a journalist for 40 years. He spent a decade in Latin America covering wars, narcotic traffickers, earthquakes, and business. His resume includes 15 years at Bloomberg News where his headlines and articles sometimes moved the market caps of companies he covered by hundreds of millions of dollars. His articles have been published worldwide, including the New York Times and the Washington Post; he's appeared on CNN, CBC, BBC, and Bloomberg TV. He was awarded a Kiplinger Fellowship at The Ohio State University.

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