Managed Care Report
Managed Care Report
• Aetna U.S. Healthcare (Blue Bell, PA) has named Kevin Enterlein general manager for the company’s south Florida market. In this position, Enterlein is responsible for sales and marketing, as well as building strong relationships with the local healthcare providers and medical communities in the region. In other news, Aetna U.S. Healthcare and Clarian Health Partners (Indianapolis) have established a long-term agreement that would allow Clarian to provide healthcare services to members of Aetna U.S. Healthcare. The agreement was announced jointly by William Loveday, president/CEO of Clarian, and Jim McNaughton, general manager for Aetna U.S. Healthcare in Indiana. Effective Dec. 1, all Aetna U.S. Healthcare members will be able to receive both inpatient and outpatient services at Methodist Hospital of Indiana, Indiana University Hospital, and Riley Hospital for Children. The agreement covers members enrolled in all of Aetna U.S. Healthcare’s health benefits products, including its Preferred Provider Organization, Point of Service, and Exclusive Provider Organization networks.
• PacifiCare Health Systems (Santa Ana, CA) reported total revenues of $2.5 million in 3Q99 ended Sept. 30, compared to 3Q98 revenues of $2.4 million. The company recorded a net income in 3Q99 of $69.3 million, $1.54 per share, compared to a 3Q98 net income of $53.2 million, $1.16 per share. During 3Q99, PacifiCare said, two transition agreements were signed with QualMed Plans for Health of Colorado and QualMed Washington Health Plans, both subsidiaries of Foundation Health Systems. The company has agreed to provide replacement healthcare coverage for up to 140,000 commercial members in 2000. QualMed employer cxlients and their employees will be able to select PacifiCare coverage in early 2000, PacifiCare said. The company expects 35% to 55% of these members to choose PaifiCare. A per member price will be paid to QualMed based on retained membership. In addition, PacifiCare finalized its acquisition of Antero Health Plans of Colorado, which added 36,000 members as of Sept. 1.
• United Wisconsin Services (Milwaukee) said it is expecting to post another loss in 3Q99, blaming higher-than-expected medical costs. The company expects to report a 3Q99 loss of 27 cents per share to 32 cents per share, reported Best’s Insurance News. That would be an improvement over 2Q99, when United Wisconsin posted a net loss of $8 million, 47 cents per share. The company attributes the decrease to higher medical costs stemming from greater utilization by patients, an increase in pharmacy costs, and higher-than-expected Medicaid costs. United Wisconsin said it is looking at increasing premiums and has spoken with state officials about increasing Medicaid reimbursements.
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