Here are 50 things to know about Aetna, Cigna, Humana, UnitedHealth Group and WellPoint — five leading health insurers in the
2. Mark T. Bertolini currently serves as chairman, president and CEO of Aetna. Mr. Bertolini assumed the role of CEO in 2010.
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4. As of March,
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7. As more people enroll in high-deductible health plans and shoulder a greater portion of the cost of care, healthcare providers face an increasing demand to be open about their prices. In 2010,
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10. In August, Aetna sued Parsippany, N.J.-based Biodiagnostic Laboratory Services and three of the company's owners who were involved in a fraud scheme in which the lab submitted millions of dollars of claims for unnecessary tests to
Cigna
1. Bloomfield, Conn.-based Cigna provides medical insurance to customers around the world. The company was formed through the combination of INA Corporation and Connecticut General Corporation in 1982.
2. In 2013, Cigna had $32.4 billion in annual revenues.
3. The health insurer has approximately 35,000 employees worldwide.
4. Cigna reported $8.73 billion in consolidated revenues for the second quarter of 2014, compared with $7.98 billion in the same quarter in 2013 — a 9 percent decrease.
5. Cigna's second-quarter 2014 net income reached $573 million, up from $505 million for the same quarter a year earlier.
6. This year has not been free from controversy for Cigna. In May, the AIDS Institute and the National Health Law Program filed a complaint with HHS' Office for Civil rights against Cigna and three other insurers alleging the companies violated a provision of the Patient Protection and Affordable Care Act that prohibits discriminating against consumers based on their medical conditions.
7. In ReviveHealth's eighth annual National Payor Survey Cigna was considered to be the most trustworthy payer. ReviveHealth's findings were based on responses from 203 hospital and health system executives about their feelings toward several health insurers. Of the 203 respondents, more than 25 percent were CEOs, CFOs, COOs or other top executives.
8. Healthsource, a Cigna subsidiary, was ranked as the fourth overall performer in Watertown, Mass.-based athenahealth's 2014 PayerView report.
9. In July, Cigna achieved its goal of creating 100 collaborative care arrangements. The company's collaborative care arrangements span 27 states and include more than 19,000 primary care physicians and more than 20,000 specialists.
10. Medicare Advantage enrollment in 2014 is concentrated among a small number of health insurers, with six companies accounting for 72 percent of the market. Of the six companies, UnitedHealthcare controls the majority of the market (20 percent), and Cigna controls the least (3 percent).
Humana
1. Louisville, Ky.-based Humana was incorporated in 1964 as a healthcare company, and the business has grown to offer several insurance products and health and wellness services.
2. The company was founded by David A. Jones, Sr. and H. Wendell Cherry.
3. As of Dec. 31, 2013, Humana had approximately 12 million medical plan members and roughly 7.8 million specialty products members.
4. In 2013, 75 percent of Humana's total premiums and services revenue were derived from contracts with the federal government, including 15 percent derived from its individual Medicare Advantage contracts in
5. For the second quarter of 2014, Humana reported net income of $712 million, down 20.3 percent from the corresponding period in 2013. The company reported total revenue of approximately $12.22 billion, an increase of 18.4 percent from the second quarter of 2013. However, total operating expenses rose 19.8 percent year-over-year to about $11.54 billion.
6. Humana has entered into many accountable care agreements. In June, Humana and UC San Diego Health System announced they were forming an accountable care organization aimed at serving Human Medicare Advantage members in
7. In July, Humana and Dallas-based Tenet Healthcare Corp. announced they were launching an ACO for Humana's Medicare Advantage members in
8. Humana was ranked as the top overall performer in Watertown, Mass.-based athenahealth's 2014 PayerView report — a ranking of private and government payers garnered from the company's cloud-based databank of national network providers.
9. Humana has been the center of controversy in 2014. In May, the AIDS Institute and the National Health Law Program filed a complaint with HHS' Office for Civil rights against Humana and three other insurers alleging the companies violated a provision of the PPACA prohibits discriminating against consumers based on their medical conditions.
10. In May, the Justice Department began a federal investigation into Humana over allegations the company overcharged the government for services provided to patients enrolled in Medicare Advantage plans. The allegations against Humana first came to light in two whistle-blower lawsuits filed against the company.
UnitedHealth Group
1. Minneapolis-based UnitedHealth Group serves clients and consumers through two platforms: UnitedHealthcare, which provides health insurance coverage and benefits services, and Optum, which focuses on information and technology-enabled health services.
2. Overall, UnitedHealth provides health benefits and services to more than 85 million people around the world. UnitedHealthcare and Optum have members in every state and more than 126 countries.
3. Stephen J. Hemsley has served as UnitedHealth's president and CEO since November 2006. He has been with the company since 1997 and previously held the position of president and COO.
4. UnitedHealth was the top ranked company in the insurance and managed care sector in Fortune magazine's "World's Most Admired Companies" list in 2014, the fourth straight year it earned the top spot. Additionally, the company — which has 133,000 employees in 21 countries — earned a top rating of 100 percent for four straight years on the Corporate Equality Index from the Human Rights Campaign Foundation.
5. However, it seems that UnitedHealth isn't as well-regarded by hospital and health system leaders as it is by its employees. ReviveHealth's eighth annual National Payor Survey, which polled 203 hospital and health system executives about their feelings toward several health insurers, found about 42 percent of hospital leaders said UnitedHealthcare was the worst at dealing with hospitals. The executives identified Humana as the second-worst payer and Blue Cross Blue Shield as the best overall payer.
6. The insurer has taken issue with the survey's findings. UnitedHealthcare spokeswoman Cheryl Randolph released the following statement in response: "UnitedHealthcare contracts with 6,000 hospitals and more than 800,000 physicians and care professionals across the country. This very selective (only 203 hospital and health system executives were interviewed for 2014), non-scientific, web-based survey misrepresents the positive relationships that UnitedHealthcare has with most hospitals. Productive, collaborative relationships between hospitals and payers are important if we are going to make progress together to improve our nation's healthcare system, and UnitedHealthcare has taken a number of steps to improve how it works with healthcare providers."
7. UnitedHealthcare is undertaking projects to promote higher-quality care at a lower cost. In May, the insurer and Arizona Care Network (formed through collaboration between San Francisco-based Dignity Health and Phoenix-bassed Abrazo Health) announced they are forming an ACO.
8. UnitedHealthcare is dealing with legal issues surrounding its coverage for mental health and substance abuse treatment. In May, a class action lawsuit was filed against the insurer alleging the company is acting in violation of the federal mental health parity law by improperly denying mental health and substance-abuse related claims. The lawsuit was filed by three UnitedHealthcare members who had been denied coverage.
9. The insurer also recently launched two text message-based wellness programs to promote healthy behavior among beneficiaries of its Medicaid benefits plans. The programs, Txt4health and Text4kids, send personalized reminders to users' cell phones to help them manage their health.
10. UnitedHealth Group's net earnings in the second quarter of fiscal year 2014 fell nearly 2 percent, from approximately $1.44 billion in 2013 to about $1.41 billion this year. The health insurer reported $32.57 billion in total revenue for the three months that ended on June 31, a 7 percent increase from $30.41 billion in the second quarter of 2013. However, total operating costs also rose 7.2 percent, from $28 billion in the second quarter of 2013 to $30 billion in 2014.
WellPoint
1. Indianapolis-based WellPoint is an independent licensee of the Blue Cross and Blue Shield Association. The company serves members as the Blue Cross licensee for California, and the Blue Cross and Blue Shield licensee in 10 states: Colorado; Connecticut; Georgia; Indiana; Kentucky; Maine; Missouri; Nevada; New Hampshire; New York; Ohio; Virginia; and Wisconsin.
2. WellPoint currently does business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield (Empire Blue Cross in New York service areas), as well as other subsidiaries.
3. Nearly 67 million people are served by WellPoint's affiliated companies, including nearly 37 million enrolled in its family or health plans.
4. In June, state regulators announced they were investigating Anthem Blue Cross and Blue Shield — a unit of WellPoint — after receiving complaints from consumers that the health insurer provided inaccurate in-network provider lists. In the six months leading up to the investigation, the health plan had been the subject of 115 provider-related consumer complaints.
5. WellPoint also reported one of the largest data breaches due to computer hacking or an IT incident, according to HHS' breach database. WellPoint's data breach was ranked as the eighth largest data breach in this category, with 32,000 people affected by the breach.
6. For the second quarter of 2014, WellPoint reported an 8.6 percent decrease in net income, from $800.1 million in 2013 to $731.1 million this year. For the second quarter, WellPoint posted total revenues of approximately $18.57 billion, up 4.4 percent from $17.69 billion for the same quarter in 2013.
7. WellPoint has started using telemedicine as a means for offering timely access to physicians at a reduced cost. Through a partnership with American Well, WellPoint beneficiaries have access to American Well's Online Care platform and are able to connect with physicians via video, secure online chat or telephone.
8. WellPoint has been an extremely active player in the insurance exchanges. As of March, the health plan had enrolled more people than any other company. Eighty percent of WellPoint's exchange enrollees were new customers to WellPoint, which means they either switched from another insurer or were previously uninsured.
9. Even with its success on the insurance exchanges, WellPoint has blamed the PPACA for some of its setbacks. The company attributed a 68 percent drop in net income in the fourth quarter of 2013 to consumers using more services than expected out of fear they would lose their plans under the reform law.
10. In August, WellPoint announced plans to change its corporate name to Anthem. Commenting on the name change, WellPoint CEO Joseph Swedish said, "We believe it is important to call ourselves by the name that people know best — Anthem." The name change is expected to take effect by the end of 2014, pending approval from shareholders.
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