Health maintenance and preferred provider organizations for medical care—HMOs and PPOs—show an uncanny membership stability year-over-year.
Business Journal research on PPOs show a roughly 1% dip in OC enrollment, which stands at 1 million; the decline is perhaps 11,000 people.
HMOs show a 2% increase in enrollment to a tick above 1.3 million, up about 25,000 in human terms.
Most major players locally offer both types of insurance and all are multistate operators headquartered elsewhere.
The directories don’t rank healthcare providers; companies are listed alphabetically.
Health
One organization in OC showing some growth is Cigna Healthcare, which hiked its PPO numbers by about 5% to 75,000, offsetting a 3.5% drop in HMO enrollees to 45,000.
Cigna’s SoCal boss Gene Rapisardi works from its Irvine digs—and, as of late, pursued a heartfelt side venture that’s benefitting charity, specifically leukemia sufferers and their families (see story page 22).
Others in both directories with a local presence include Anthem Blue Cross and Blue Shield of California, each in Costa Mesa; Health Net Insurance Co. in Huntington Beach; and UnitedHealthcare in Cypress.
A local player among PPOs is MultiPlan Inc. in Lake Forest; HMO provider SCAN Health Plan is in Long Beach.
HMO giant Kaiser Permanente, based in Oakland with offices in Anaheim, reported a 1% gain in local enrollees to 574,000.
Human Services
Various providers on the directories have been active in the past year with services for local workers or corporate clients. Aetna Better Health for California provides a good portion of Covered California and medical coverage, which sometimes falls to lower-income enrollees. A California Health Care Foundation report shows an increase in medical two years ago and a decrease last year.
Retailer CVS bought Aetna last year for $69 billion, which also got the drugstore chain First Health, a PPO provider.
Blue Shield has about 5,400 physicians in OC and 50,000 statewide. It offers mail-order prescriptions and clinical and nursing access through Caremark.com and CVS, respectively. Its alternative medicine lineup includes acupuncture, massage, chiropractic, and online health classes.
Its “Fitness Your Way” program provides access to 10,000 gyms at about $25 a month for members.
Telemedicine
Blue Cross has “Live Health Online” which lets patients “see” a doctor from home as part of its telemedicine work, and they’re not alone.
Kaiser’s efforts in this area include an interface via smartphone app. Members can schedule appointments, view test results, refill prescriptions, message doctors, and manage their health records.
Much of Cigna’s telemedicine work is by phone.
Many providers are moving to such e-visits and phone consultations.
