Orange County’s top eight health maintenance organizations grew slowly during the 12 months through July.
The HMOs are ranked on the Business Journal’s annual list by local membership figures. Those combined for 1,227,751 local members, flat from last year’s 1,229,768 membership.
Industry observers had anticipated growth to possibly heat up through two large potential merger and acquisition deals involving three of the listed plans.
That could stall, however; the U.S. Department of Justice said last month that it would sue to block Indianapolis-based Anthem Inc.’s proposed $54 billion buy of Bloomfield, Conn.-based Cigna Corp. and West Hartford, Conn.-based Aetna Inc.’s $34 billion deal for Humana Inc., a Louisville, Ky.-based plan that doesn’t appear on the Business Journal’s list.
Anthem through its Anthem Blue Cross is the list’s No. 2 plan, with an estimated 290,000 Orange County members, unchanged from a year ago. Cigna ranks No. 7 with 58,541 OC members.
Aetna business unit Aetna Health of California ranks No. 6 with 61,055 members.
Four of the ranked plans posted membership growth, while two posted declines. Two figures are Business Journal estimates.
• Perennial leader Kaiser Permanente reported 530,000 members in Orange County, up 10% over last year’s 480,000.
Kaiser is a self-contained health system with affiliated doctors and hospitals in Irvine and Anaheim. It’s picked up membership in recent years.
• Orange County membership of No. 3, Blue Shield of California, rose 1% to 100,838. Blue Shield is based in San Francisco.
• The steepest membership decline among the rankings came at No. 4, Health Net of California Inc. The number of local members of the unit of St. Louis-based Centene Corp. fell 16% to 97,000.
Centene, which traditionally has served government healthcare accounts, finalized its $6 billion buy of Health Net in March. It acquired Health Net in order to increase its presence in the commercial market.
Centene has said it wouldn’t be interested in bidding on any divestitures that could be ordered by regulators as a condition of the Aetna-Humana deal.
• UnitedHealthcare, a business unit of Minneapolis’ UnitedHealth Group Inc., is again No. 5 on the list. The Cypress-based health plan had 62,800 local enrollees, unchanged from a year ago.
• No. 7, Cigna, has been making local moves. The company said in October that it would develop a pair of health plans with Irvine-based St. Joseph Hoag Health separately from the potential Anthem deal. The health insurer and St. Joseph Hoag Health will jointly offer St. Joseph Hoag Select, an HMO, and St. Joseph Health Flex, an “exclusive provider organization” with a narrowly tailored network.
Select and Flex will give members access to nine OC hospitals, along with eight medical groups and physician networks with about 1,700 doctors and numerous outpatient and urgent-care facilities.
• No. 8 on the list is Long Beach-based Scan Health Plan, which serves Medicare beneficiaries. Scan posted a 7% membership gain to 27,517.
PPOs
Preferred provider organizations in the Business Journal’s unranked directory combined for a 12% local membership increase to 1,006,153 members.
Seven plans provided enrollment figures. The Business Journal estimated the membership of the remaining two plans.
PPOs historically are 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 that aren’t covered by HMOs, such as weight-loss surgery.
• Membership at San Diego-based First Health, a PPO run by Aetna business unit Coventry Healthcare, more than tripled to an estimated 101,000.
• Aetna Health of California’s PPO saw its local membership fall 7% to 119,092.
• The Business Journal estimates that Anthem Blue Cross has the largest PPO in the county, with 290,000 members.
