Orange County’s largest health maintenance and primary provider organizations (HMOs and PPOs) saw stable membership levels in the past year, though the disruption to the healthcare industry due to the coronavirus pandemic has kept providers on their toes, implementing new services and embracing innovative delivery models in recent months.
The Business Journal research on HMOs show a 1.5% increase in area enrollment to 757,328 members. SCAN Health Plan, a Medicare Advantage insurance provider for the senior market, led the growth with a 12.2% rise to 41,424 local HMO enrollees.
It also surged ahead with a 7% uptick in nationwide HMO members to 218,813.
Cigna trailed behind SCAN, with local HMO enrollment up 2% to 45,904; their nationwide HMO numbers dropped about 11% to 354,233.
Meanwhile, total local PPO memberships increased about a tenth of a percent to 191,021.
Companies are unranked and listed alphabetically in both directories; several providers dropped off the list after declining to provide information specific to OC.
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.
Oakland-based Kaiser Permanente, with 580,000 local HMO enrollees and OC’s third-largest hospital, partnered with consumer electronics firm GrandPad in Orange last month to expand its telehealth services for seniors.
User-friendly tablet maker GrandPad has experienced soaring demand in recent months, and touts its product as a perfect fit for providers seeking better engagement from its senior populations.
A Kaiser Permanente spokesperson told the Business Journal its area offices have also transitioned to a Telemedicine Appointment program, while it continues to repurpose its facilities for immediate needs such as pharmacy pickup and drive-thru COVID-19 testing.
SCAN Shake-Up
Long Beach-based SCAN Health’s longtime Chief Executive Chris Wing stepped down at the end of June, stating plans to return to his roots in “investor-owned health care services.”
He’s succeeded by Sachin Jain, who took the top spot at the beginning of July.
Jain was most recently chief executive of CareMore Health and Aspire Health Inc., where he oversaw its expansion from four to 32 states.
SCAN Health added Whittier-based PIH Health and CareMore Health to its provider network in OC and Los Angeles this year, the latter of which provides virtual care offerings in disease management, behavioral health and programs that address senior loneliness and social isolation, among others.
It’s also received praise in recent months for its virtual reality-powered Trading Ages program, in partnership with digital agency Primacy, which trains staff on the “lived experience” of older adults and offers insight into age-related health challenges such loss of dexterity, vision, hearing and more—a challenge that is likely more pronounced in the virtual new normal.
Telehealth Takes
More change is in store for most HMOs and PPOs with a local presence this year.
With a renewed urgency around virtual healthcare services, Bloomfield, Conn.-based PPO and HMO provider Cigna (NYSE: CI), expanded its digital services for its Medicare Advantage and individual and family plan members in June.
New additions include waiving all cost-sharing for medical and behavioral telehealth visits in the U.S. and doubling its meal benefit for discharged hospital patients enrolled in its Medicare Advantage plans in order to help its members “focus on getting and staying well” in these times, the company said.
PPO provider First Health, which was acquired by CVS along with its parent company Aetna for $69 billion in 2018, is also using telemedicine to drive better patient outcomes.
The Attain by Aetna app, which was developed in partnership with Apple and works with its smartwatch, provides users with rewards based on physical activities such as steps per day.
Devices Demand Too
Like First Health and Kaiser, more providers are embracing monitoring devices and wearable technologies to collect and analyze data and monitor patients’ health remotely.
As a result, both large and small device makers in Orange County have benefitted from relaxed regulations around telemedicine and providers’ increased interest in such services in recent months, such as:
• Irvine-based Masimo Corp. (Nasdaq: MASI), well on its way to reaching its CEO Joe Kiani’s goal of $1 billion in sales this year. The $12.8 billion-valued firm said second-quarter earnings rose 31% to $301 million last week.
• Coala Life Inc. has seen fierce demand for its mobile chest sensor, which measures patients’ heartbeats and monitor irregularities, according to President Philip Siberg, who recently moved to OC to oversee the company’s entrance into the U.S. market. It uses a unique prescription payment model, which means providers don’t pay a fee until it’s prescribed and can bill insurance providers at the same time.
• The augmented reality-powered headset device from Ocutrx Vision Technologies LLC in Irvine can’t come fast enough for eyecare professionals, according to its Chief Executive Michael Freeman. Its visual assistance device will launch in 2021, and will provide telehealth services via its recently announced partnership with AT&T.
