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Earnings Plummet for Mass Health Insurers

Friday, August 17, 2012


The state's top health insurers posted markedly lower earnings for the second quarter of 2012 than in the same period last year. Net incomes were down by 50 percent or more as insurers continued to struggle to keep premiums low.

With 2.8 million members, Blue Cross Blue Shield of Massachusetts is the state's largest insurance provider, but its earnings shrank to $28.3 million over the months of April, May and June this year, roughly half of its $56.5 million net income over the same period in 2011.

Harvard Pilgrim Health Care experienced a slightly larger decrease in earnings. Its 1,184,000 members brought the health insurer a net income of $5.9 million in the second quarter, compared to $13.5 million the year before.

But Tufts Health Plan seems to have been hit the hardest, with its $2.3 million in second quarter earnings representing a 94 percent decrease from the $35.9 million the company brought in during the same three months in 2011.

At 991,000 members, Tufts enrollment was up 31 percent year-over-year, but it recorded an operating loss of $2.5 million this quarter, while it banked $24.9 million in operating income the prior year.

However, Senior Vice President and Chief Financial Officer Umesh Kurpad said the numbers were in line with Tufts' expectations.

"We are particularly pleased with the increased diversification of our company's business that makes us even better-positioned to deliver on our mission to improve the health and wellness of the diverse communities we serve," Kurpad said. "We will continue to make strategic investments to ensure that we serve our targeted markets and segments."

Worcester's own Fallon Community Health Plan, which serves its 208,366 members throughout the Commonwealth, announced lower numbers as well. Fallon's $4.3 million in earnings during the second quarter was almost 70 percent less than the $13.6 million the not-for-profit health services provider booked in 2011.

Like their colleagues at Tufts, Fallon officials said the earnings reports did not come as a surprise.

“Our results are consistent with our expectations and a reflection of the solid business fundamentals we have in place to support the diverse product portfolio FCHP offers,” said R. Scott Walker, FCHP Executive Vice President and Chief Financial Officer.

“We continue to work in partnership with providers, customers and other stakeholders to ensure the many different communities we serve have access to affordable, high-quality health care.” 

According to Vera Tice, managing director of the Healthcare Delivery Institute at Worcester Polytechnic Institute one of the most significant drivers of declining earnings for Massachusetts health insurers is the increasing shortage of primary care providers.

"In Massachusetts, the average wait to see a new primary care physician is about two months, while for the rest of the nation, the average is just under three weeks," Tice said.

In most cases, if people can't get in to see a primary care physician in a reasonable amount of time, they head to the emergency room, where the cost of care is much greater. In other cases, patients will put off doctor visits due to the lack of availability, and when they finally do go in for an appointment, their condition has worsened, resulting in higher medical bills.

"The long-predicted shortage of doctors in the U.S. is underway," Tice said.

"That coupled with a long list of free preventative services that will kick in under the Obama health law on January 1, 2014 will exacerbate the problem even more, putting a huge strain on the healthcare delivery system. Our current system will not be able to deliver on the increased demand for primary care services that will be necessary to provide these additional services."

With earnings already dropping even as subscriber numbers rise, Tice foresees more of the these types of reports from health insurers in the near future.

"The result that we are starting to see...will become worse as more and more primary care physicians opt to move to 'concierge medicine' in which they see fewer patients for fees that are independent of third party payers. This will leave even more patients looking for new primary care physicians and a tiered system in which those who can afford it on their own will get more and better care."


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