Monday, March 17, 2014

Are Kaiser and Providence Winners or Losers?

The Oregonian has reported that the big winner in getting Cover Oregon customer "sales" (which does not mean the first payment has been made) is Moda.

Carrier - Policies [sold] as of March 6
Atrio - 16
BridgeSpan - 11
Oregon's Health CO-OP - 212
Health Republic - 810
Kaiser - 3,205
LifeWise - 770
Moda - 22,403
Health Net  - 838
PacificSource  - 927
Providence - 1,633
Trillium - 3
Total - 30,828

The question is whether Cover Oregon buyers help or hurt a health care insurance business. My brother tells me that Kaiser management was sweating last summer about having a big influx of new clients and not enough doctors, staff and facilities to care for them.  It doesn't look like that will be a problem now.

So, given the fact that young people are not buying health care insurance in the numbers hoped for, are health insurers with modest gains like Kaiser and Providence in a better position than Moda/ODS with its 22,000 new clients.

Playing into the analysis is the need to expand medical facilities and personnel as well as not getting a lot of younger people to help underwrite the new clients who are older and sicker than originally planned for.

So, who is the bigger winner? Moda with big gains? Kaiser and Providence with very modest gains?


MAX Redline said...

I'm going to guess that Moda (ODS) gains, but that their clients lose. Wait times are likely to increase for their clients, whereas that shouldn't be as much of a problem for Kaiser/Providence patients.

Moreover, Kaiser added The Portland Clinic facilities effective Jan. 1 of this year, which adds another cushion in terms of obtaining prompt visitation. So far as I know, neither Moda nor Providence expanded their networks.

Moreover, Kaiser opened their Hillsboro medical center last August - the first new hospital built in the area in quite a while.

T. D. said...

I just asked a similar question on one of your posts, Max, but do you know if Moda has a good network?

Trying to figure out the impact of anything is so hard in this because Obamacare policy is convoluted and based on assumptions that have not been clearly publicized (like how many young people with no or very few health problems subsidizing older people are necessary to make it financially viable for health care insurers).

That's why I wonder if getting a lot of Cover Oregon people is a drag not a good. But, that assumes they are mostly from the pool of previously uninsured (who might be assumed to have more health problems than normal because of being uninsured and going without health care).

However, the Cover Oregon people may be like you (previously insured but canceled). So, their moving to Moda is actually a win for Moda--except for the need to expand facilities and personnel.

MAX Redline said...

Moda doesn't actually run any facilities, TD. They contract with providers. So trying to track their network is kind of an exercise in futility; the network can morph without warning, which is something that I imagine many folks don't realize. So more people moving to Moda is a plus for their bottom line; they have no facilities and few personnel.

T. D. said...

Max, I knew that ODS had a "you choose your own doctor" sort of plan, and the doctor has to find/contract facilities. But somebody has to come up with facilities and personnel to care for the 250% increase of their individual patient base especially as regards specialized or hospital care. It will be interesting to see how this works out.

Interesting stats in this article: