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Boosts in Managed Care Enrollment Seen Across The Board

Aetna and Health Net of California See Big Increases in PPO Enrollment New Data Release of Managed Market Surveyor from HealthLeaders-InterStudy

Reveals New Trends in the Ever-Evolving Managed Care Industry

NASHVILLE, Tenn., Dec. 19 /PRNewswire/ -- HealthLeaders-InterStudy, the leading provider of managed care market intelligence, reports that managed care enrollment from January 2007 to July 2007 has seen significant shifts across the board, including growth at the plan, product and geographic levels. The details of this membership growth, from Medicare and PPOs to national and local health plans, is revealed in the new release of Managed Market Surveyor, a healthcare market intelligence product that examines the details of health plan enrollment growth.

"Fully insured managed care plans increased by 4.9 percent to 126.5 million from January 2007 to July 2007," states Jane Dubose, Associate Director of Health Plan Analysis for HealthLeaders-InterStudy. "Much of this growth is due in large part to the growth in the public sector."

Medicare managed care registered a 12 percent increase in enrollment during the period with 8.4 million beneficiaries in a variety of managed care plans. The market is seeing the effects of the Medicare Modernization Act, which boosted Medicare managed care by increasing reimbursement rates to health plans and by creating new products in this segment. Meanwhile, the Medicaid managed care sector remained relatively flat with a mere 1 percentage growth, even as several states have undertaken dramatic expansions of their managed care program in an effort to slow the growth of medical costs related to Medicaid.

Among the national health plans showing increased enrollment in 2007 was Aetna, whose PPO posted 27.5 percent overall gains. Aetna's growth came from nearly all of its markets -- but most notably in Connecticut, Ohio, Hawaii, Iowa, Delaware and Minnesota. However, Aetna's HMO dropped nearly 5 percent in membership in the six-month period. The company has signed dozens of new provider agreements and put more focus on pricing and product development in order to register gains.

Health Net of California also appeared to be making a play in the PPO market with a 47 percent increase in PPO members. Health Net has aligned its company around segments, such as the individual and small group segment, to bring more focus to those product lines and improve the focus on profitability and growth of the products. Health Net has substantially grown its provider network, particularly in California, doubling the number of contracted providers.

On a local health plan level, Massachusetts' Fallon Community Health Plan's membership recovery continued into 2007 with a gain of some 18.5 percent in HMO covered lives. Fallon has made significant strides to expand its reach from outside its stronghold of Worcester County and is reaping the benefits of a wider provider network. In addition, membership has come from the plan's participation in Massachusetts' near-universal healthcare reform efforts.

"For anyone in the healthcare industry, it's the specifics of enrollment numbers that are most important," states Russell Workman, Principal Director of Data Operations for HealthLeaders-InterStudy. "Managed Market Surveyor allows users to dive down into a geographic area, move across to a specific health plan that is dominant in that area, and then pull back to a larger scale, to see how that health plan plays nationally. This kind of exploration can reveal trends and developments that are hard to detect otherwise."

Managed Market Surveyor is currently available with enrollment information from July 2007.

About Managed Market Surveyor

Managed Market Surveyor offers the most comprehensive description of how managed care lives in a geographical region are insured: HMO, PPO, managed Medicare, managed Medicaid, uninsured, or privately insured. This enrollment database provides plan level data at the state, county, and MSA levels.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy is the authoritative source for managed care data, analysis, and news. For more information, please visit

All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.

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Kelly Morphy



SOURCE HealthLeaders-InterStudy
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