Orange County’s health maintenance organizations posted mixed growth in the past year.
The biggest news: UnitedHealth Group Inc.’s buy of former No. 4 PacifiCare Health Systems Inc., which nearly tripled the combined company’s local presence. The $9.2 billion acquisition closed in January.
The nine HMOs on this week’s Business Journal list reported a 14% increase in OC membership to 1.2 million people, compared to the previous year.
The list is ranked by enrollment, with figures compiled from the California Department of Managed Health Care and the companies themselves.
The gain largely was a result of the PacifiCare and UnitedHealth deal.
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Excluding PacifiCare/UnitedHealth, HMOs on the list recorded a 4% rise in membership during the past year.
OC and California are considered mature HMO markets,the state is an influential region in the growth and development of the health plan.
Huge membership gains for HMOs were common in the 1980s and 1990s, but the pace of enrollment slowed considerably when different forms of health insurance plans emerged.
Meanwhile, a backlash against HMOs from consumers, doctors and politicians took a bite out of enrollment, though the sentiments have improved during the past decade.
As in past years, the list had a caveat: Figures for No. 3 Blue Cross of California and No. 6 Cigna Healthcare of California were estimates.
The Business Journal estimated that Blue Cross of California had 225,000 local members. The health plan’s nationwide enrollment was off 2% to 4.5 million in the past year.
Blue Cross is a unit of WellPoint Inc., the insurance company created by the 2004 deal between WellPoint Health Networks Inc., which was based in Woodland Hills, and Indianapolis-based Anthem Inc.
Philadelphia-based Cigna had an estimated 50,000 OC members.
Without the estimates, OC membership in HMOs grew 19%. The majority of membership figures were as of June 30.
Kaiser Permanente continued its long-running reign as OC’s largest HMO, with 371,569 members, up 4% from last year.
PacifiCare/UnitedHealth had the most powerful growth spurt during the year,its enrollment shot up 87% to 230,000 members after it combined with UnitedHealth.
The combined plan providers used their heft to sign scores of new contracts with businesses and others, including with the county of Orange. PacifiCare’s Secure Horizons senior unit was an enrollment driver, too.
Blue Shield of California was No. 4 , with a 12% rise in enrollment to 143,659.
Health Net of California was No. 5 with 137,209 members, up 13% from a year ago.
Woodland Hills-based Health Net gained membership in the region earlier this year when it bought the health plan assets of Universal Care Inc. of Long Beach for an undisclosed amount.
Universal Care, which was No. 7 on last year’s list, was a family-owned and operated HMO that had some financial problems and drew scrutiny from state regulators.
No. 7 Aetna Health of California said it had 38,000 local members, a 4% drop from a year ago.
Long Beach-based Scan Health Plan, a regional HMO that concentrates on Medicare, posted a 15% enrollment gain to 16,522 members. It notched the No. 8 spot on the list.
Great-West Healthcare, a unit of Englewood, Colo.-based Great-West Life & Annuity Insurance Co., rounded out the HMO list at No. 9.
PPO Directory
Like previous years, more than a few of the companies on the Business Journal’s preferred provider organization directory declined to provide OC enrollment numbers.
The plan providers that gave local numbers posted a 7% decline in enrollment in the past year.
PPOs, which give their members more leeway in selecting their doctors, albeit at a higher cost, gained popularity at the expense of health maintenance organizations in the past decade.
But fluctuations in the economy and a bit of relaxation among some HMOs in terms of access to specialist doctors could limit their appeal.
The plans were particularly popular during the go-go years of the late 1990s, when competition to hire workers was fierce and employers were more likely to use benefit packages as hiring enticements.
As on the HMO list, PacifiCare/United Healthcare showed the largest enrollment growth. Its OC membership was up 15% to 30,000.
Prior to its acquisition by UnitedHealth, PacifiCare had introduced PPO plans as part of its effort to diversify beyond its traditional HMO image.
Other PPO plans that provided local figures included Blue Shield of California, which reported flat membership at 109,269.
Health Net of California’s membership also was flat at 23,228.
Aetna Health of California said its local PPO enrollment was up 2% to 90,000.
