Orange County’s top health maintenance organizations experienced modest growth during the 12 months through July. Those ranked on the Business Journal’s annual list by local membership figures combined for 1.3 million local members, up 2% from last year’s 1.2 million.
• Oakland-based Kaiser Permanente leads the pack with 560,000 local members, up 5.7% from a year earlier. The self-contained integrated system—comprised of a health plan that bears insurance risk; medical groups of physicians; and a hospital system—plans to drive down healthcare costs through investment in technology and facilities, such as a new La Habra medical office building.
The facility, which opened last week, consists of a 28,300-square-foot “high-technology” office. Some of the concepts include appointment check-in via cellphone 24 hours in advance, as well as self-service check-in and payment kiosks. The example of how future Kaiser medical office buildings will be is the first such facility to be built in OC and one of 10 medical centers to be rolled out throughout Southern California.
• Indianapolis-based Anthem Inc. through its Anthem Blue Cross continues to be the list’s No. 2 plan with an estimated 290,000 local members, followed by Blue Shield of California, Health Net of California Inc. and UnitedHealthcare, ranked No. 3 through No. 5.
• The steepest membership decline among ranked HMOs came at No. 4, Health Net of California. Local membership of the unit of St. Louis-based Centene Corp. fell 7% to 90,000. The insurer said it lost members in its individual health plan business.
• Cigna Healthcare jumped from No. 7 to No. 6 with 61,620 OC members, switching places with Aetna Health of California, whose membership is at an estimated 61,055. Both companies are based in Connecticut.
Cigna has been growing its local presence as it expands its joint venture product with Irvine-based St. Joseph Hoag Health, HMO St. Joseph Hoag Select, and St. Joseph Health Flex, an “exclusive provider organization” with a narrowly tailored network. It’s broadened that market, forming other joint venture partnerships with healthcare providers in San Diego and Los Angeles County.
• No. 8 on the list is Long Beach-based Scan Health Plan, which serves Medicare beneficiaries. Scan posted a nearly 6% membership gain to just over 29,000. This year, the health plan includes a new program that offers lower co-payments for prescription drugs when filling prescriptions at a “preferred pharmacy,” including Albertsons, Costco, Express Scripts, Rite Aid and Walgreens.
PPOs
Preferred provider organizations on the Business Journal’s directory combined for a 1 million-plus local membership, up about 3% from a year earlier.
Three plans provided enrollment figures, and the Business Journal estimated the membership of the remaining six plans.
PPOs are historically more expensive than HMOs for users. The tradeoffs, however, include more options and flexibility on certain aspects of healthcare, including the right to see specialists without a gatekeeper primary care doctor, as well as coverage for some elective procedures, such as weight-loss surgery, that aren’t covered by HMOs.
There are now also lesser-known exclusive provider organization plans. EPOs are much like PPOs in terms of flexibility, offering services to members such as the ability to make appointments directly with providers with no prior physician referral necessary. EPOs, however, have extremely limited provider networks and require 100% self-pay if members visit providers outside of the network.
• Membership at Costa Mesa-based Blue Shield of California increased by 15% to 215,653.
• Cigna Healthcare saw a more modest increase of 3%, totaling 76,208 local members.
• Huntington Beach-based Health Net Life Insurance Co. experienced the steepest membership decline—20% to 16,000 members.
