Here are 125 things to know about Blue Cross Blue Shield, UnitedHealthcare, Aetna, Cigna and Humana — five leading health insurers in the U.S.
Blue Cross Blue Shield
1. Blue Cross was founded in 1929 as a way to provide prepaid hospital care. A decade later, Blue Shield was founded to provide reimbursement for physician services. The Blue Cross Association and National Association of Blue Shield Plans merged in 1982 to form the Blue Cross and Blue Shield Association.
2. Scott Serota currently leads BCBSA as president and CEO. He has held this position since 2000, following terms as COO, a senior executive and executive vice president for system development. He previously served as president and CEO of Chicago-based Rush Prudential Health Plans, which was sold to WellPoint Health Networks in 2000.
3. The BCBS system offers a full spectrum of healthcare coverage, including coverage for large employer groups, small businesses and individuals, as well as Medicaid and Medicare plans.
4. One in three Americans — 106 million — are BCBS beneficiaries. BCBS companies also hold the largest privately underwritten health insurance contract in the world through the Federal Employee Program, or the Federal Employee Health Benefits Program, which insures more than half — 5.3 million — of federal government employees, dependents and retirees, according to the payer. BCBS provides 52 million Medicaid and 42 million Medicare beneficiaries with healthcare coverage as well.
5. BCBS companies operate in every U.S. state, the District of Columbia and Puerto Rico.
6. The Blues are entirely independent and license one or both of Blue Cross and Blue Shield's brands to operate in distinct markets across the country. Of the 36 BCBS companies, the largest is the publicly-traded Anthem, which stretches across 14 states, and includes Rocky Mountain Hospital and Medical Service (Colorado and Nevada), Anthem Health Plans (Connecticut), BCBS of Georgia, BCBS Healthcare Plan of Georgia, Anthem Insurance Companies (Indiana), Anthem Health Plans of Kentucky, Anthem Health Plans of Maine, RightCHOICE Managed Care (Missouri), Healthy Alliance Life Insurance Co. (Missouri), HMO Missouri, Anthem Health Plans of New Hampshire, Community Insurance Co. (Ohio), Anthem Health Plans of Virginia, BCBS of Wisconsin.
Health Care Service Corp., CareFirst, The Regence Group and Highmark also serve multiple states. Health Care Service Corp. operates the following plans: BCBS of Illinois, BCBS of Montana, BCBS of New Mexico, BCBS of Oklahoma and BCBS of Texas. CareFirst includes CareFirst of Maryland, CareFirst BlueChoice and Group Hospitalization Medical Services. The Regence Group includes Regence BlueShield of Idaho, Regence BCBS of Oregon, Regence BCBS of Utah and Regence Blue Shield (Washington). Highmark includes Highmark BCBS (Pennsylvania), Highmark Blue Shield (Pennsylvania), Highmark BCBS West Virginia and Highmark BCBS Delaware.
7. Chicago-based Health Care Service Corp., a BCBS licensee and the largest nonprofit health insurer in the country, posted a $281.9 million loss in 2014, compared to a $684.3 million surplus the year before, due to a significant increase in the number of medical claims as a result of the Patient Protection and Affordable Care Act and people gaining insurance coverage through the exchanges.
8. Anthem, the largest BCBS company, reported better-than-expected profits for the first quarter of 2015, posting a net income of $856.2 million, up from $701 million for the first quarter last year.
9. The nonprofit status of some Blues outfits has been a point of contention. While some companies are publicly traded, such as Anthem, others have maintained a nonprofit status. Blue Shield of California was stripped of its state tax-exempt status in August 2014, but the news was announced this March. The California Franchise Tax Board revoked its status, which the payer has held since it was founded in 1939, after a state audit. Though no information has been released, the tax-exempt status was likely removed because Blue Shield of California was holding $4.2 billion in its financial reserves, which is four times larger than BCBSA requires its members to hold to pay claims, according to NPR. The company has contributed $325 million to its charitable foundation in the last 10 years.
10. Many payers, including BCBS plans, requested double-digit rate increases for plans created under the PPACA next year to cover the medical costs of the newly insured. Blues plans in Maryland, New Mexico and Tennessee all requested increases of 30 percent or more, and BCBS Illinois requested a 23.4 percent increase for individual plans and a 29.1 percent increase for an HMO plan, according to Politico. BCBS of North Carolina is asking for a 25.7 percent increase in premiums, according to Triad Business Journal. The increased rates have not yet been approved.
11. The Blues collectively boosted value-based care spending to $71 billion in 2014, reflecting a 9 percent increase in claims tied to value-based programs since 2013.
12. Patient-centered BCBS programs generated $1 billion in savings in 2013, according to BCBSA. The portfolio includes accountable care organizations, patient-centered medical homes and other programs for a total of 570 patient-centered care programs for more than 25 million customers and 228,000 physicians.
13. BCBS has launched 450 ACOs across 32 states with more than 111,000 physicians.
14. The Blues host 69 PCMHs in 43 states and Washington, D.C. More than 56,000 physicians participate in the payer's PCMH models.
The BCBS antitrust lawsuits
15. Two federal antitrust lawsuits against all BCBS companies and BCBSA have recently grabbed headlines. The lawsuits allege BCBS insurers' "cartel-like" operations limit competition and drive up premiums.
16. One case was brought on behalf of healthcare providers and the other on behalf of individual and small-employer customers. The suits were combined into one claim by a federal judicial panel in Alabama and the plaintiffs are now seeking class-action status.
17. BCBS denied the allegations. It says their licensing model — which gives companies exclusive rights to use the BCBS brand in specific regions — is not unlawful and has been in existence for decades without previous antitrust action.
18. The case comes down to the judicial interpretation of the BCBS model. Whether BCBS is a franchise or was purposefully designed to reduce competition is the crux of the case, according to Barak D. Richman, a Duke law professor.
19. The plaintiffs have conflicting interests. Glenn Melnick, a professor at the University of Southern California, pointed out in The Wall Street Journal that higher reimbursement rates are of interest for providers, but would lead to higher premiums for customers.
20. No judgments have been made on the merits of the case, but it was not dismissed last year by U.S. District Judge R. David Proctor, who said the plaintiffs "have alleged a viable market-allocation scheme."
Rankings, disputes and news
21. According to athenahealth's annual PayerView report, the Blues have the strongest presence in the Top 10 Performers, with BCBS Washington Regence, BCBS Maryland, BCBS Louisiana, BCBS Pennsylvania Capital BlueCross, BCBS North Carolina and BCBS North Carolina Blue Medicare holding six spots. Payers were ranked based on metrics such as days in accounts receivable, claim resolution rate, denial rate and more.
22. BCBS plans were rated the No.1 plan for overall member satisfaction for the Heartland region — which includes Arkansas, Iowa, Kansas, Missouri, Nebraska and Oklahoma — and the Illinois-Indiana region, Ohio, New Hampshire, Pennsylvania and Texas, where it tied for No. 1 with UnitedHealthcare, according to the annual J.D. Power Member Health Plan Study. The study is based on consumer responses in six categories: coverage and benefits, provider choice, information and communication, claims processing, cost and customer service.
23. CareFirst BCBS announced in May it was the victim of a cyberattack that potentially compromised the data of almost one-third of its customers — 1.1 million members — making it the third hacking discovered at a BCBS company since the beginning of the year. Anthem also announced a breach in February this year, putting information at risk for approximately 80 million former and current customers and employees. A cyberattack reported in March at Premera Blue Cross compromised the data of 11 million customers.
24. Pittsburgh-based UPMC and Highmark have been embroiled in a dispute since 2011, when the payer moved to acquire West Penn Allegheny Health System, UPMC's biggest competitor. In response, UPMC decided not to renew its contract with the payer, forcing Highmark customers to seek care outside of the system or pay out-of-network fees. Most recently, a judge ordered UPMC to continue to provide in-network access to Highmark Medicare Advantage members until 2019, or the duration of the consent decree the companies entered into in June 2014.
25. BCBSA announced in April plans to launch a private health insurance exchange to help transition Medicare-eligible retirees from group health benefits to individual Medicare coverage. The exchange will offer supplemental Medicare insurance, or Medigap, as well as Medicare Advantage and Medicare Part D plans.
Blue Cross plans, state by state
Alabama: Blue Cross and Blue Shield
Alaska: Premera Blue Cross Blue Shield
Arizona: Blue Cross and Blue Shield
Arkansas: Blue Cross and Blue Shield
California: Anthem Blue Cross; Blue Shield
Colorado: Anthem Blue Cross and Blue Shield
Connecticut: Anthem Blue Cross and Blue Shield
Delaware: Highmark Blue Cross Blue Shield
District of Columbia: CareFirst Blue Cross Blue Shield
Florida: Blue Cross and Blue Shield
Georgia: Blue Cross and Blue Shield
Hawaii: Blue Cross Blue Shield of Hawaii
Idaho: Blue Cross; Regence BlueShield of Idaho
Illinois: Blue Cross and Blue Shield
Indiana: Anthem Blue Cross Blue Shield
Iowa: Wellmark Blue Cross and Blue Shield
Kansas: Blue Cross and Blue Shield
Kentucky: Anthem Blue Cross and Blue Shield
Louisiana: Blue Cross and Blue Shield
Maine: Anthem Blue Cross and Blue Shield
Maryland: CareFirst Blue Cross Blue Shield
Massachusetts: Blue Cross and Blue Shield
Michigan: Blue Cross and Blue Shield
Minnesota: Blue Cross and Blue Shield
Mississippi: Blue Cross and Blue Shield
Missouri: Anthem Blue Cross Blue Shield; BlueCross and BlueShield of Kansas City
Montana: Blue Cross and Blue Shield
Nebraska: Blue Cross and Blue Shield
Nevada: Anthem Blue Cross and Blue Shield
New Hampshire: Anthem Blue Cross and Blue Shield
New Jersey: Horizon Blue Cross and Blue Shield
New Mexico: Blue Cross and Blue Shield
New York: BlueCross & BlueShield of Western; BlueShield of Northeastern; Empire Blue Cross and Blue Shield; Excellus BlueCross BlueShield
North Carolina: Blue Cross and Blue Shield
North Dakota: Blue Cross and Blue Shield
Ohio: Anthem Blue Cross and Blue Shield
Oklahoma: Blue Cross and Blue Shield
Oregon: Regence BlueCross BlueShield of Oregon
Pennsylvania: Highmark Blue Shield; Capital BlueCross (Harrisburg); Highmark Blue Cross Blue Shield (Pittsburgh); Independence Blue Cross (Philadelphia)
Puerto Rico: BlueCross BlueShield of Puerto Rico
Rhode Island: Blue Cross and Blue Shield
South Carolina: Blue Cross and Blue Shield
South Dakota: Wellmark Blue Cross and Blue Shield
Tennessee: Blue Cross and Blue Shield
Texas: Blue Cross and Blue Shield
Utah: Regence BlueCross BlueShield of Utah
Vermont: Blue Cross and Blue Shield
Virginia: Anthem Blue Cross and Blue Shield and CareFirst BlueCross BlueShield
Washington: Premera Blue Cross; Regence BlueShield
West Virginia: Highmark Blue Cross Blue Shield West Virginia
Wisconsin: Anthem Blue Cross and Blue Shield
Wyoming: Blue Cross and Blue Shield
1. Minneapolis-based UnitedHealthcare operates under parent company UnitedHealth Group. UnitedHealth Group was incorporated in 1974 under the name Charter Med by a group of healthcare professionals and physicians. In 1977, United HealthCare Corp. was created and became the parent of Charter Med. It wasn't until 1998 when United HealthCare Corp. became known as UnitedHealth Group, and the company launched six independent business segments, one of which was the UnitedHealthcare of today.
2. UnitedHealth Group's other service line is Optum, a health services platform that includes solutions for population health management, care delivery and clinical and operational improvement. Optum features three platforms — OptumHealth, OptumInsight and OptumRx — providing services for health management, advisory consulting and pharmacy benefit management services, respectively.
3. David Wichmann, president and CFO of UnitedHealth Group, currently oversees operations of UnitedHealthcare. He assumed these duties in February 2015, after then-CEO of UnitedHealthcare Gail Boudreaux stepped down from her position for undisclosed reasons after serving in the position since 2008. Mr. Wichmann will transition out of his role as CFO over the next six to 12 months.
4. UnitedHealth Group employs approximately 168,000 individuals in 21 countries, including Australia, Canada, China, India, Philippines, Ireland, Italy and the United Kingdom.
5. In first quarter 2015, UnitedHealth Group (including Optum financials) reported revenue of $35.8 billion, a 12.6 percent increase from the first quarter 2014's $31.8 billion. On its own, UnitedHealthcare's Q1 2015 revenue totaled $32.6 billion, up 11.3 percent from $29.3 billion in Q1 2014. UnitedHealth Group's profit for Q1 2015 totaled $1.4 billion, up from $1.1 billion Q1 2014.
6. In the past three years, UnitedHealthcare has nearly tripled its total value-based payments to providers, which now total approximately $37 billion. The payer expects to double that number by 2018, paying $65 billion tied to improved quality and outcomes.
7. UnitedHealthcare covers approximately 45 million individuals worldwide. UnitedHealth Group's services serve more than 6,100 healthcare facilities and 855,000 physicians and caregivers.
8. UnitedHealthcare offers health benefits to five distinct groups. In the community and state plans, the payer provides managed care solutions to state Medicaid programs. The employer and individual plans offer consumer-oriented benefits. UnitedHealthcare also offers Medicare and retirement plans for those ages 50 and above, as well as military and veterans plans to serve the needs of military service members, retirees and their family members. Additionally, UnitedHealthcare has a global presence, mainly in Brazil.
9. UnitedHealthcare offers products on 23 state exchanges, including 15 states where the payer offers Medicaid plans.
10. The payer offers health plans tailored to individuals with specific chronic diseases, such as diabetes. UnitedHealthcare launched its diabetes-specific program in 2009, making it the first-ever health plan specifically for patients with diabetes or pre-diabetes. Under the plan, there is no cost for routine diabetes care, but members in the program must adhere to preventive, evidence-based guidelines from the American Diabetes Association.
11. Research from Mark Farrah Associates indicates UnitedHealthcare's total membership was the only one out of its top competitors to see membership growth decline from fourth quarter 2013 to fourth quarter 2014. UnitedHealthcare's membership growth fell by 1 percent, while Aetna's grew 5.9 percent, Cigna's grew 2.7 percent and Anthem grew 5.2 percent, according to the findings.
Accountable care agreements
12. UnitedHealthcare plans to add an additional 250 accountable care organizations to its current list of programs, bringing the grand total to more than 720 ACOs. The payer announced in February that 11 million plan participants receive value-based care through its ACOs.
13. Some recent accountable care relationship updates of UnitedHealthcare's include plans with Downers Grove, Ill.-based Advocate Health Care to expand accountable care from 5,500 Medicare Advantage beneficiaries to more than 80,000 UnitedHealthcare members, Raleigh, N.C.-based WakeMed Key Community Care to improve care coordination for more than 175,000 beneficiaries receiving care from WKCC physicians, and Mountain View, Calif.-based Palo Alto Medical foundation to launch a new ACO for more than 63,000 beneficiaries.
14. UnitedHealthcare was involved in some payer-hospital conflict this year as it worked to renegotiate its contract with Charlotte, N.C.-based Carolinas HealthCare. The contract between the two parties expired Feb. 28, 2015. It took approximately two months after their contract expired to agree upon a new one in April, but the contract is retroactive to March 1 so beneficiaries did not experience a disruption in benefits.
15. In 2009, UnitedHealthcare launched its patient-centered medical home program with primary care practices in Arizona, Colorado, Ohio, New York and Rhode Island. In this model, primary care physicians serve as individuals' coordinators of care to help reduce fragmentation across the care continuum.
Rankings and ratings
16. In 2015, UnitedHealth Group ranked No. 1 on Fortune's "World's Most Admired Companies" list in the insurance and managed care section for the fifth year in a row. Additionally, the payer received a top rating of 100 percent on the Human Rights Campaign's 2015 Corporate Equality Index and was named a Top 100 Military Friendly Employer and Military Spouse Friendly Employer in 2015 by Victory Media, which publishes G.I. Jobs and Military Spousemagazines.
17. UnitedHealthcare plans were ranked the No. 1 for member satisfaction in the Texas region, tied with BlueCross BlueShield of Texas, according to the annual J.D. Power Member Health Plan Study in 2015. The payer tied for third place with CareFirst BlueCross BlueShield in the Mid-Atlantic region, which includes Maryland, Virginia and Washington, D.C.
18. In athenahealth's PayerView 2015 report, UnitedHealthcare came in at 53 out of 166 payers. The report ranks payer performance based on accounts receivable, first-pass claim resolution rate, denial rate and provider collection burden, among other metrics.
19. As millennials enter the workforce, UnitedHealth Group is one place they want to end up. According to a survey from the National Society of High School Scholars that collected responses from more than 18,000 students between the ages of 15 and 29, UnitedHealth Group is No. 23 on the list of 25 specific companies for which millennials most want to work.
20. UnitedHealthcare partnered with three telemedicine providers and will cover video consultations. Through the telemedicine service providers — Doctor on Demand, Optum's NowClinic and American Well — UnitedHealthcare members will be able to access a physician at any time. Currently, this coverage is only offered to self-funded employer customers, but the payer plans to extend coverage to employer-sponsored and individual plan participants in 2016.
21. In 2014, UnitedHealthcare launched its Health4Me mobile app, which allows plan participants to pay medical bills on their smartphones. The app also allows users to search for physicians, locate urgent care facilities, manage prescription claims and speak with nurses about health concerns, among other offerings.
22. Along with the AARP, UnitedHealthcare launched The Longevity Network, a digital platform offering a hub for individuals ages 50 and above. AARP and UnitedHealthcare have worked in partnership since 2008. UnitedHealthcare provides AARP members Medicare Supplement Insurance Plans.
23. In April, the payer announced a health incentive partnership with Walgreens. Through the collaboration, UnitedHealthcare members can earn Walgreens Balance Reward points for healthy behaviors and activities. When individuals log daily exercise, healthy eating and other health-positive activities on UnitedHealthcare's Health4Me mobile app, they earn extra Walgreens Balance Reward points. The program will be piloted for members in Arizona and Illinois.
UnitedHealthcare in the news
24. In May, UnitedHealthcare settled a decade-long lawsuit that alleged the payer purposefully withheld payments to meet financial goals. The N.C. Medical Society filed the lawsuit against UnitedHealthcare in 2004, alleging UnitedHealthcare "would systematically deny payments to NCMS members for medically necessary claims to achieve internal financial targets without regard for individual patient medical needs." UnitedHealthcare will settle for $11.5 million.
25. According to a Wall Street Journal report, UnitedHealth Group is discussing a takeover deal with Aetna that would be valued at more than $40 billion. News of this extended offer closely follows news that Anthem recently approached Cigna with a takeover deal valued at approximately $45 billion. Additionally, Aetna is speculated to be considering buying Humana.
1. Aetna's company name is inspired by Mt.Etna — an 11,000-foot volcano on the eastern shores of Sicily, Italy, which is the most active volcano in Europe.
2. Aetna was founded in 1853, and Eliphalet A. Bulkeley was the company's first president. The insurer introduced major medical coverage in 1951, when a labor shortage paired with wage freezes made employee benefits all the more critical for worker retention. Aetna paid its first Medicare claim in 1966 and created an HMO subsidiary in 1973.
3. As of March 2015, Aetna had 23.7 million medical members, approximately 15.5 million dental members and approximately 15.4 million pharmacy benefit management services members.
4. Major Aetna players include:
- Mark T. Bertolini, chairman and CEO of Aetna, who serves as the company's executive sponsor for diversity, participates in several Aetna employee resource groups, and maintains a blog to communicate with employees.
- Karen S. Rohan, president of Aetna, who is responsible for the company's core institutional businesses.
- Shawn M. Guertin, executive vice president, CFO and chief enterprise risk officer of Aetna, who is responsible for leading all of the corporation's financial activities
- Harold Paz, MD, executive vice president and CMO of Aetna, who leads clinical strategy and policy at the intersection of all of Aetna’s domestic and global businesses.
5. As of March 2015, Aetna's network, which stretches across the U.S. and much of the world, consisted of more than 1.1 million healthcare professionals, more than 674,000 primary care physicians and specialists, and 5,589 hospitals.
6. Aetna participates in Patient Protection and Affordable Care Act health insurance marketplaces. In May 2014, Aetna reported it had more than 600,000 exchange enrollees.
7 Aetna has roughly 49,350 employees.
8. In January, Aetna set its wage floor to $16 an hour for its lowest paid employees, boosting the employees' incomes by as much as 33 percent.
9. The wage increase was expected to cost Aetna $26 million annually, but Mr. Bertolini predicted the higher wages will allow Aetna to offset some costs by reducing the $120 million spent each year on employee turnover-related costs.
Merger talks and finances
10. Aetna is among the major payers involved in the merger frenzy talks that are going on in the health insurance sector. Within the last two weeks Anthem has made two takeover bids for Cigna, and Cigna has rejected both of them. Additionally, The Wall Street Journal reports Aetna has demonstrated interest in taking over Humana.
11. Most recently, UnitedHealth Group approached Aetna about a takeover deal that would likely be valued at more than $40 billion.
12. Aetna's 2014 revenue was approximately $58 billion.
13. Aetna reported net income of $777.5 million on $15.1 billion in revenue for the first quarter of fiscal 2015, up from net income of $665.5 million on $14 billion in revenue a year earlier.
14. Aetna's operating revenue was up 8 percent in the first quarter of fiscal year 2015, growing to $15.1 billion.
15. The company's financial growth was partially attributable to an increase in medical membership, which totaled approximately 23.7 million as of March 31 — a sequential increase of 122,000 members.
16. Based on its Q1 financials, Aetna projects operating earnings per share for the full year 2015 in the range of $7.20 to $7.40, up from its original guidance of at least $7.00.
Accountable care agreements
17. Approximately 3.2 million Aetna members receive care through accountable care agreements, and 30 percent of Aetna's claims payments go to providers practicing value-based care. Aetna plans to increase the number of such claims payments to 50 percent by 2018 and 75 percent by 2020.
18. Here are a few accountable care agreements the payer recently struck with providers: In April, Atlanta-based Emory Healthcare and Aetna announced plans to form a new accountable care organization. In May, Cigna and Hackensack, N.J.-based Regional Cancer Care Associates announced the launch of a value-based initiative to improve care for patients receiving chemotherapy. That same month, Aetna and Omaha, Neb.-based CHI Health announced the launch of an ACO for employers.
19. A 2012 case study including 750 Medicare Advantage members receiving services from the accountable care agreement between Aetna and Portland, Maine-based NovaHealth found patients had 50 percent fewer hospital days, 45 percent fewer admissions and 56 percent fewer readmissions than the rest of Maine's Medicaid population. Additionally, healthcare costs for patients in the pilot program were 16.5 to 33 percent lower than costs for members not in the program. The case study was published in Health Affairs.
20. Aetna has also formed patient-centered medical homes. Aetna and Purchase, N.Y.-based WESTMED Medical Group were able to reduce hospital admissions among their patients by 35 percent in the first year after forming their patient-centered medical home. WESTMED physicians also reportedly met or exceeded 90 percent of their targeted goals for diabetes management and screenings, cancer screenings and heart disease.
Legal disputes, rankings and other issues
21. Aetna was named No. 32. in Diversity publication DiversityInc's ranking of Top 50 Companies for Diversity, an annual list now in its 16th year. More than 1,600 companies participated in DiversityInc's survey in 2015.
22. In the 2015 edition of athenahealth's PayerView report, Aetna ranked second overall among commercial and major payers. Payers were ranked based on metrics such as days in accounts receivable, claim resolution rate, denial rate and more.
23. Aetna is among the key players in the healthcare industry that joined the Clear Choices Campaign, a healthcare coalition which will advocate for more transparent, accountable and consumer-friendly health markets.
24. This year has not been free from controversy for Aetna. Earlier this month, East Texas Medical Center Tyler filed a lawsuit in excess of $1 million against three of the largest health insurance companies in the state — Blue Cross Blue Shield of Texas, Aetna and Cigna — claiming exclusion from their preferred provider networks has created "serious and negative consumer impact."
25. In February, Aetna filed a lawsuit alleging that North Cypress (Texas) MedicalCenter and its CEO engaged in an illegal kickback scheme and used deceptive billing practices that led Aetna Life Insurance to overpay the physician-owned community hospital by as much as $120 million.
1. Cigna provides medical insurance to customers in 30 countries and jurisdictions, with more than 86 million customer relationships worldwide. Cigna offers international private medical insurance, including cancer, maternity and psychiatric care, through the Cigna Global Health Options program.
2. In 2014, Cigna reported $35 billion in revenues, $2 billion in adjusted income from operations, assets of $55.9 billion and $10.8 billion in shareholders' equity.
3. Cigna's global network includes more than 1 million partnerships with healthcare professionals, clinics and facilities including:
- 89,000 participating behavioral healthcare professionals and 11,400 facilities and clinics
- 74,000 contracted pharmacies 69,700 vision healthcare providers in more than 24,800 locations
- 134,000 dental PPO professionals and 20,000 dental HMO professionals
4. Although the vast majority of Cigna's business is commercial, it offers a Medicare/Medicaid line of business through Cigna HealthSpring. About 85 percent of Cigna's commercial business is with employers that self-insure and about 15 percent is fully insured, where Cigna assumes the risk.
5. Cigna has 459,000 Medicare Advantage customers, 59,000 Medicaid customers, 1.2 million Medicare prescription drug customers and processed 158 million medical claims overall in 2014.
6. States with the largest number of Cigna medical customers are Texas, California, Florida, Tennessee and New York.
7. The health insurer has approximately 37,000 employees.
8. Major Cigna players include:
- David Cordani, president and CEO, who, outside of Cigna, has competed in more than 125 triathlons.
- Thomas A. McCarthy, executive vice president and CFO, who has more than 31 years' experience in healthcare and insurance services.
- Alan Muney, MD, CMO of Cigna since 2011, who has more than 26 years experience leading health plan operations and in medical group practice management.
- Mark Boxer, executive vice president and global CIO of Cigna since 2011, who is responsible for driving the company's worldwide technology strategy.
- Lisa Bacus, executive vice president and global chief marketing officer since 2013, has won numerous marketing awards for various business and marketing efforts.
9. Cigna is counted among the 'Big 5' for-profit health insurers, along with UnitedHealth Group, Anthem, Humana and Aetna, who collectively insure more than half of the insured population, or more than 100 million people.
10. Cigna is among the major payers involved in merger talks in the health insurance sector. Within the last two weeks, Anthem made two takeover bids for Cigna — the most recent of which at about $175 per share — and Cigna rejected both. Humana has also entered into takeover talks with both Cigna and Aetna.
11. Shares of Cigna jumped nearly 12 percent June 15 after it was reported that Anthem made those two takeover bids, according to a Hartford Courant report. Cigna shares jumped more than 3 percent in late May when the company is said to have approached competitor Humana regarding a potential buyout, sources told Bloomberg.
Finances and customers
12. Cigna reported net income of $533 million for the first quarter of fiscal 2015, up from net income of $528 million on $8.5 billion in revenue a year earlier.
13. Cigna reported consolidated revenues of nearly $9.5 billion for the first quarter of fiscal 2015, up about 11 percent from a year earlier.
14. The company's premiums and fees for the first quarter of 2015 were up 12 percent from a year earlier, largely driven by customer growth in Cigna's commercial and government businesses.
15. Cigna's total medical customers grew to 14.7 million in the first quarter of 2015, compared with 14.2 million a year earlier.
16. Based on its first-quarter financials, Cigna expects full-year adjusted income from operations in the range of $8.15 to $8.50 per share, up from its previous forecast of $8 to $8.40 per share.
Collaborative care agreements
17. In July 2014, Cigna achieved its goal of creating 100 collaborative care arrangements. At that time, the company's collaborative care arrangements spanned nearly 30 states and included more than 19,000 primary care physicians and more than 20,000 specialists. Currently, Cigna has 114 Collaborative Accountable Care arrangements in 28 states, covering 1.2 million customers.
18. Cigna Collaborative Care, a value-based initiative similar to an accountable care organization, hasshown successful quality outcomes and reduced costs in OB/GYN practices in Florida and Texas. Cigna plans to launch up to six additional OB/GYN collaborative care pilots this year.
Rankings, legal battles and acquisitions
19. In the 2015 edition of athenahealth's PayerView report, Cigna ranked third overall among commercial and major payers. Payers were ranked based on metrics such as days in accounts receivable, claim resolution rate, denial rate and more.
20. In the 2015 ReviveHealth National Payor Survey, published by athenahealth, Cigna was rated the No. 1 plan in overall member satisfaction for the Southwest region of the United States, according to the annual J.D. Power Member Health Plan Study. The study, which is in its ninth year, measures satisfaction among members of 134 health plans in 18 regions across the U.S. The study examines six factors: coverage and benefits, provider choice, information and communication, claims processing, cost, and customer service. Member satisfaction is calculated on a 1,000-point scale.
21. Cigna was ranked No. 90 on Fortune's list of 500 companies that generated the most revenue for their respective fiscal years. It rank lower than the other four 'Big 5' health insurance companies.
22. In Revive Health's ninth annual National Payor Survey, Cigna was considered the most trustworthy payer for the second year in a row. Revive Health's findings were based on responses from more than 200 hospital and health system leaders about their feelings toward several health insurers.
23. This year has not been free from controversy for Cigna. Earlier this month, East Texas Medical Center Tyler filed a lawsuit in excess of $1 million against three of the largest health insurance companies in the state — Blue Cross Blue Shield of Texas, Aetna and Cigna — claiming exclusion from their preferred provider networks has created "serious and negative consumer impact."
24. Cigna is among payers that joined the Health Care Payment Learning and Action Network, an advisory group established to provide a forum for public-private partnerships to help the U.S. healthcare payment system meet or exceed recently established Medicare goals for value-based payments and alternative payment models.
25. Cigna is no stranger to acquisitions. In January 2012, Cigna achieved a major acquisition with its purchase of HealthSpring, one of the largest Medicare Advantage plans in the country, for $3.8 billion. Other recent acquisitions include:
- In March of 2015, Cigna completed its acquisition of Piscataway, N.J.-based QualCare Alliance Networks, a group that serves approximately 200,000 customers in self-funded health plans and has more than 900,000 customer relationships.
- In 2013, Cigna completed its acquisition of Alegis Care, a portfolio company of Triton Pacific Capital Partners. The financial terms of the deal were not disclosed.
- In 2012, Cigna acquired a 51 percent share in Finans Emeklilik, the sixth-largest life and pension provider in Turkey.
- In 2012, Cigna acquired Great American Supplemental Benefits, which offers supplemental insurance products for Medicare providers, for $326 million.
1. Major players in Humana's past and present include:
- Founders David A. Jones, Sr. and H. Wendell Cherry, who were attorneys.
- CEO Bruce D. Broussard, who, prior to Humana, worked within a variety of healthcare sectors, including oncology, pharmaceuticals, assisted living/senior housing, home care, physician practice management, surgical centers and dental networks.
- CFO Brian Kane, whose previous health insurance work has included coverage of the national and government-focused managed care organizations.
- Board Chairman Kurt J. Hilzinger, a partner with New York City-based private equity firm Court Square Capital Partners.
2. Humana began as a nursing home company called Extendicare.
3. The company's focus shifted to hospitals, and the name was changed to Humana in 1974.
4. Humana has medical membership in all 50 states, Washington, D.C. and Puerto Rico.
5. As of Dec. 31, 2013, Humana had approximately 12 million medical plan members and roughly 7.8 million specialty products members.
Will a competing insurer acquire Humana?
6. Humana has recently garnered widespread media attention, as there have been whispers of Humana possibly being acquired by a competing health insurer.
7. Humana is exploring a possible sale of the company after Cigna approached the health insurer about a potential deal, according to a Bloomberg report. Along with Cigna, Aetna has also shown interest in taking over Humana, according to The Wall Street Journal.
8. Major insurers are interested in acquiring Humana due to the bulk of the company's revenue coming from administering Medicare Advantage plans, which is an area other insurers are looking to expand.
9. Goldman Sachs Group is advising Humana on the possible sale.
10. Humana reported net income of $430 million on $13.8 billion in revenue for the first quarter of fiscal 2015, up from net income of $368 million on $11.7 billion in revenue a year earlier.
11. Humana has been involved in various transactions this year. In April, Humana announced its home care division, Humana At Home, had acquired Deerfield Beach, Fla.-based Your Home Advantage, a nurse practitioner home health service.
12. In March, Humana announced it was selling Concentra, its occupational health and physical therapy services arm, for $1.06 billion.
Accountable care agreements
14. Humana has entered into many accountable care agreements. In March, Brookfield-based Integrated Health Network of Wisconsin in March agreed to partner with Humana on a three-year accountable care agreement for Humana's Medicare Advantage beneficiaries.
15. In February, Humana announced a new multi-year accountable care agreement with HealthSpan Physicians, a network of 200 primary care physicians based in Cincinnati.
16. As of March, 53 percent of Humana's members were in accountable care relationships.
17. Humana's accountable care relationships have seen some signs of success: Within its accountable care continuum, Humana reported improved costs, decreased ER visits, decreased inpatient admissions and better screening compliance for various measures like cholesterol and colorectal cancer, compared to Humana members treated in traditional, fee-for-service and original Medicare settings.
18. As of March, Humana was on course to have more than 75 percent in accountable care relationships by 2017.
Rankings, disputes and initiatives
19. In the 2015 edition of athenahealth's PayerView report, Humana ranked first overall among major payers and was the only national commercial payer in the Top 10. Payers were ranked based on metrics such as days in accounts receivable, claim resolution rate, denial rate and more.
20. Humana was rated the No. 1 plan in overall member satisfaction for the East South Central region of the United States, according to the annual J.D. Power Member Health Plan Study. The study, which is in its ninth year, measures satisfaction among members of 134 health plans in 18 regions across the U.S. The study examines six factors: coverage and benefits, provider choice, information and communication, claims processing, cost, and customer service. Member satisfaction is calculated on a 1,000-point scale.
21. Humana has been part of disputes with hospitals. It was announced in February that a 20-year relationship between Humana and the University of Chicago Medicine would come to an end April 1, affecting approximately 1,750 patients.
22. Humana has recently been part of legal proceedings. Humana disclosed in a regulatory filing that it was the subject of a federal probe, which is related to a whistle-blower lawsuit filed against the health insurer. According to the filing, the U.S. Department of Justice issued an information request to Humana concerning the health insurer's Medicare Part C risk adjustment practices.
23. Humana is among payers that joined the Health Care Payment Learning and Action Network, an advisory group that was established to provide a forum for public-private partnerships to help the U.S. healthcare payment system meet or exceed recently established Medicare goals for value-based payments and alternative payment models.
24. Humana launched two population health management services suites this year. In March, the insurer announcedthe formation of Transcend and Transcend Insights, extended suites of management services designed to assist healthcare systems, physicians and care teams in improving population health management efforts.
Thoughts on Humana
25. A number of healthcare industry experts have commented on Humana this year. Below are some of their comments.
- "Our first-quarter achievements included substantial revenue and membership growth, announcement of the launch of our population health technology business Transcend Insights, the pending sale of Concentra and the completion of our accelerated share repurchase program, as well as strong pretax income," Mr. Broussard said when Humana released its first-quarter financial results. "These achievements contributed meaningfully to the advancement of our integrated care delivery model with its data-driven focus on the consumer, powered by our disciplined approach to capital allocation — which, taken together, represents a sustainable competitive advantage for Humana."
- "Humana has long been thought of as the national leader in Medicare advantage plans. It has seemed bit to lose share in some commercial markets but has doubled down in this area quite successfully," said Scott Becker, JD, publisher of Becker's Healthcare.