C&S 2006 HMO Study

2006 STATEWIDE HMO & SPECIAL PROGRAMS
ENROLLMENT STUDY

The 2006 California Statewide HMO & Special Programs Enrollment Study is Cattaneo & Stroud’s tenth annual analysis of California HMO enrollment by county. The study provides HMO enrollment compared to the total eligible population for four major lines of business: Commercial, Medi-Cal, Medicare and Healthy Families. All health plan membership data are for the month of March 2006.

C&S would like to THANK THE PLANS, the DEPARTMENT OF HEALTH SERVICES AND THE CALIFORNIA ASSOCIATION OF HEALTH PLANS for their assistance in this study.

DEFINITIONS

Commercial Enrollment – includes HMO (standard group, both large & small), individual, point-of-service, Aid for Infants & Mothers, California Kids, county sponsored Healthy Kids Programs and capitated administrative services only members - - all of which are reportable to the Department of Managed Health Care for Knox-Keene Licensed Health Care Service Plans.

Medi-Cal – programs administered by the Department of Health Services including: 2-Plan County Programs, County Organized Health Systems, Fee-For-Service Managed Care, Geographic Managed Care, Prepaid Health Plans, Primary Care Case Management and Special Projects.

Medicare – programs administered by the Centers for Medicare & Medicaid Services including: Medicare+Choice, Demonstration Contracts and Program for All Inclusive Care (PACE).

Healthy Families – administered by the California Major Risk Medical Insurance Board which uses the HMO or EPO networks of the participating health plans.

Population Adjustments

The California Department of Finance’s population estimates for January 2005 were adjusted by the Department when published in May 2006 with the January 2006 estimates. C&S revised the March 2005 data to reflect the adjusted 2005 population.

PLANS COVERED, DATA SOURCES & LIMITATIONS

TABLE 1 identifies all plans included in the study. Sources of data are identified in each table. Participating health plans have specified that county level data by plan will not be published in the report. However, TABLE 4 provides the ranking of each plan within each county by the four lines of business.

TABLE 4AA, shows the ranking of CalOptima, HealthNet and LA Care with their gross Medi-Cal lives assigned by the Department of Managed Health Care Services. These three plans subcontract some or all of their assigned Medi-Cal lives to other health plans, and in all tables other than Table 4AA, the net Medi-Cal lives (after subcontracting) are provided (the subcontracted lives are counted at the subcontractor level).

It should be noted that in the Commercial Enrollment, there is inevitably some double counting of individuals due to a husband and wife or domestic partner working for different employers and receiving family coverage from each employer. No estimate is provided to account for this duplicate coverage issue. It should also be noted that the total eligible commercial population used to calculate percent of Californians covered by HMOs includes an undetermined number of uninsured individuals.

If you are comparing the 2006 reports for commercial enrollment to prior years, please read this note.

STATEWIDE HIGHLIGHTS

OVERALL ENROLLMENT - 17,442,631 individuals or 47.4% of the total California population obtained health insurance from either HMO plans or Special Programs in March 2006. Overall enrollment of the plans increased 150,152 lives from March 2005, a 0.9% increase, and a decrease of -0.3% net of California’s population growth of 1.1%. Enrollment increased overall because small gains in Commercial, Medicare and Health Families membership more than compensated small drops in Medi-Cal enrollees. This is the first time in the last five years that commercial enrollment increased, and the third year in a row for Medi-Cal to fall. The business line enrollment comparisons from 2005 showed:

	Commercial HMO enrollment INCREASED by 150,152 (0.9%) members, or a net LOSS of -0.2% over the commercial eligible population increase of 301,896;

	Medi-Cal HMO enrollment DECREASED by 9,821 ( -0.1%) members, while the eligible population INCREASED by 14,539, a rate of 0.2%, consequently leading to enrollment net of population DECLINING at a -0.5% rate;

	Medicare HMO enrollment INCREASED by 14,255 (1.0%) members, or a net DECREASE of 1.9% net of the 96,873 increase in Medicare eligible population; and

	Healthy Families enrollment INCREASED by 30,511 (1.4%) members.

POPULATION PENETRATION CALCULATIONS

The following 2006 statewide calculations demonstrate the methodology used for population penetration percents for both statewide and county tables for all years:

	All lines of business (total enrollment) ¸ (total California population, Jan 1, 2006) x 100 = 46.9%

	Commercial (total Commercial Enrollment) ¸ (total Calif population – (Healthy Families Enrollment + Medi-Cal Eligibles + (Medicare Eligibles – Medicare/Medi-Cal Eligibles))) x 100 = 45.6% (Note that the total eligible population in this category includes uninsured)

	Medicare (total Medicare Enrollment – Medicare/Medi-Cal Enrollment) ¸ (Medicare Eligibles – Medicare/Medi-Cal Eligibles) x 100 = 39.8%

	Medi-Cal (total Medi-Cal Enrollment) ¸ (total Medi-Cal Eligibles including Medicare/Medi-Cal Eligibles) x 100 = 50.1%

The following Tables are included (all files are in PDF format - if you don't have Adobe Acrobat Reader, click and download the FREE program now.)