Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
February 25,
2016 Volume 22 Issue 4
Aetna Inc.’s planned acquisition of
Humana Inc. took a big step forward this month when the Florida Office of
Insurance Regulation (FOIR) approved the deal without requiring any
divestitures. Florida is perhaps Humana’s key Medicare Advantage market, where
it operates under both its own name and as CarePlus and where it had more than
$1 billion in MA premiums in 2014. Humana led the state MA market with a 40%
share of premiums in 2014, according to the most recent FOIR data, more than
double that of second place UnitedHealth Group.
And while the Aetna purchase of Humana
still must overcome several more hurdles, including clearance by the U.S.
Department of Justice, Aetna Chairman and CEO Mark Bertolini said in the
company’s Feb. 1 quarterly earnings call with investors that it already has
obtained seven of the state approvals required to close the deal. (The company
on Feb. 15 updated that number to 10 out of the 20 it needs.) Bertolini
declined to identify the states granting those approvals, but he said “none of
them have been contentious.”
Securities analysts, however, continue
to expect the federal government to require some MA divestitures before the
acquisition can close. Analyst Thomas Carroll of Stifel, for instance, cited in
a Feb. 1 research note Louisiana, West Virginia, Kentucky and Ohio as among
markets where some MA “membership will be jettisoned.”
State Finds MA Doesn’t Compete With FFS
FOIR, in its consent order dated Feb.
15, found that MA “competes directly with Traditional Medicare.” It cited as
evidence for this a data analysis for 2013-2015 finding that 21% to 25% of
Aetna or Humana enrollees transition from MA to fee-for-service (FFS) Medicare
annually. Moreover, FOIR said, a Harvard University study found 5% to 7% of FFS
Medicare enrollees in giant Miami-Dade County move from FFS to MA annually.
Based on such factors, even though the
Florida MA market itself is concentrated, “the impact of the proposed
acquisition affects the [overall Medicare market] concentration by only a
minimal amount.” This is so even though MA had a 40% Medicare market share in
Florida in 2015, FOIR said. While FOIR had considered requiring divestitures to
reduce market concentration in light of the Aetna-Humana deal, it concluded
that “may be disruptive to policyholders and also may be short term in nature”
since beneficiaries could choose a different insurer. The only new requirements
the department therefore put on the deal, which was unveiled last July (MAN
7/30/15, p. 1), were unrelated to MA.
The Florida action is likely to bolster
the optimism about MA exhibited by Aetna in its quarterly earnings call. The
company had “another strong” MA Annual Election Period (AEP), Bertolini said
(see story, p. 1), and it now projects that “we will grow our membership by
over 6% in the first quarter of 2016, including 10% growth in our individual
Medicare Advantage membership.” Moreover, he said, Aetna achieved its targeted
pretax operating margin in the individual MA business “one year ahead of our
projections.”
Separately, Bertolini also predicted
that Aetna will grow its membership in stand-alone Medicare Prescription Drug
Plans (PDPs) by more than 450,000 members in the first quarter.
Aetna reported having 1,251,000 MA
members and 863,000 PDP enrollees on Dec. 31. The company posted Medicare
premium revenue for the 2015 fourth quarter of $3.90 billion, up from $3.68
billion in the year-ago period. Its Medicare MLR, Carroll reported, was 82.1%
last quarter, well below the 87.0% in the fourth period of 2014.
Humana Admits Faulty MA Pricing for
2015
If things are heading in the right
direction in MA for Aetna, they seem to have been heading in the wrong
direction in MA for Humana recently. In reporting on Feb. 10 lower net income
for the fourth quarter than in the year-ago period (MAN 2/11/16, p. 6),
Humana said that MA operating results in 2015 were “negatively impacted by
certain developments related to the company’s product pricing assumptions for
2015.” The insurer explained that these included recording
“lower-than-anticipated reductions in inpatient admissions” and
lower-than-expected “financial claim recovery levels.”
Some analysts have criticized the
company for growing too fast in MA in the past, and Humana seemed in the
fourth-quarter earnings report to be acknowledging there was some truth in
those rebukes. The insurer’s pretax profit margin for its individual MA
business in 2015 was about 3%, according to Humana, which said it expects to
get to the target 4.5% to 5% on that business line with the aid of “operational
corrections we made in 2015.” This would include “meaningful margin improvement
in our core individual Medicare Advantage business for 2016,” said Chief
Financial Officer Brian Kane.
Analyst Christine Arnold of Cowen &
Co. pointed out in a Feb. 10 research note that Humana said fourth-quarter and
early 2016 “claims recoveries have stabilized, while inpatient admissions are
better than expected.”
View the Florida Consent Order by
visiting the Feb. 11 From the Editor entry at MAN's
subscriber-only Web page: www.aishealth.com/newsletters/medicareadvantagenews.
Contact Carroll at tacarroll@stifel.com and Arnold at christine.arnold@cowen.com.
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