Managed Care Report
Managed Care Report
• Blue Cross and Blue Shield of Massachusetts (BCBSMA; Boston) is planning to offer an HMO that requires no referrals for patients who want to see a specialist. By doing away with referrals, BCBSMA hopes to attract more subscribers roughly 135,000 members within five years to its Access Blue HMO, BCBSMA Vice President of Marketing Alan Rosenberg told the Boston Globe. Under the new plan, patients will have a $30 copayment, which the Globe reported is triple the average physician copayment, every time they see one of BCBSMA’s network of 7,500 specialists. Visits to primary care physicians, obstetricians, and gynecologists will carry a copayment of $10 per visit. BCBSMA will continue to sell its standard HMO Blue insurance, the Globe reported.
• United Wisconsin Services (Milwaukee) has formed a new managed care company that consolidates five of its specialty managed care subsidiaries. The new company, Innovative Resource Group, joins United Wisconsin’s medical and behavioral health management services, case management, employee assistance programs, workers’ compensation and disability case management, and pharmacy services management. United Wisconsin reported a net loss for 2Q99, citing costs to reorganize and additional claims being paid out as the company works to catch up on a backlog, reported Best’s Insurance News. United Wisconsin recorded a net loss of $8 million, 47 cents per share, compared to a net income in 2Q98 of $4.9 million, 30 cents per share. Revenues for the quarter totaled $174.9 million, up 6.8% from 2Q98 revenues of $163.8 million.
• Humana (Louisville, KY) CEO Gregory Wolf resigned last week after 20 months at the company. Wolf replaced Humana’s chairman and cofounder, David Jones, who retired as CEO in December 1997. When asked by the Courier-Journal of Louisville if the company’s recent poor financial results were the reason for accepting Wolf’s resignation, Jones said, "People can speculate, obviously, but I’m not going to engage in speculation about that."
• Aetna (Hartford, CT) says it is only rumors that the company is targeting Oxford Health Plans (Norwalk, CT) for acquisition and has put those rumors to rest. Aetna said in a statement last week that it plans to focus its energies on its acquisition of Prudential HealthCare, a $1 billion deal that was completed last week. With this acquisition, Aetna has more than 18 million managed care members.
• Trigon Healthcare (Richmond, VA) reported a 12% drop in 2Q99 net income, posting a net income of $18.3 million, 43 cents per share, compared to a 2Q98 net income of $20.7 million, 49 cents per share. Revenues rose 8% to $587.9 million, the company said. Financial results for 2Q99 include net realized losses of $4.2 million.
• Maxicare Health Plans (Los Angeles) Chairman Paul Dupee was named to the additional post of CEO. Dupee succeeded Peter Ratican as chairman earlier this year.
• First American Group of Companies (Richton Park, IL) has completed the previously announced acquisition of Community Health Choice of Illinois (Chicago). The acquisition will most likely have no effect on Community health’s members or providers, said First America President Daniel Splain. First American is the holding company for a number of managed care related ventures, including American Health Care Providers. With the addition of Community Health, First American now serves more than 170,000 subscribers in Illinois.
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