What Do You Think Will Happen to the Big PFFS Companies

[Tom Highway]

The big ones I can think of are Humana and Today's Options (Universal American).

We all pretty much know that PFFS is going to be pretty much the first part of MA to go by the wayside, since counties having 2 or more HMO plans will mean any PFFS plan will have to contract providers. That's a given.

But what is the business plan of the big plans going forward? They can't be planning on just letting all their MA business leave to other plans, can they? Are these companies scrambling to get contracts, acquiring smaller regional plans with contracts in place, or doing something else?

What do you think will happen to these plans?

 

[MrMack]

Coventry has completely left the Market of PFFS.

UHC, I have heard will keep it going for 2010. They want to keep their business going. Don't know about the other companies.

 

[mississippiagent]

cigna is the only thing i've seen in writting for 2010
still pending cms approval

 

[captain94]

Universal American is trying to get contracts in there largest areas.

 

[jdeasy]

Universal American is trying to get contracts in there largest areas.

It looks as though Pyramid is going to ride out the PFFS wave thru 2010 since they don't have to have networks until 2011. They will work on getting networks in the areas they want to stay active in, the rest they will let die on the vine at the end of 2010. Same for Humana, they really pushed their PPo this year, they will continue to do so, especially with their captives.

Who knows where premiums will end up once the capitation is reduced to where companies get the same as medicare costs.

 

[Cenla Agent]

Humana is basically a HMO company when it comes to MA, even though they have been heavily involved in PFFS as well. They have been in the market since Medicare HMO's began, back when it was called Medicare+Choice and various other names. Same with United and the various companies it has acquired (Pacificare.)

The big question is what is going to happen with smaller companies like Universal American and others who currently don't have the infrastructure to build networks because they don't have any other kind of health operation e.g. group, major medical, Medicare HMO. Looks like they will either have to start building or get out come 2011. Some of these are basically Med Supp companies that decided to dip their toe in the MA water after the passage of the MMA in 2003 and in some cases didn't seriously get into the market until 2006-07.

 

[MrMack]

UHC might buy some of the smaller companies and get even bigger.

 

[Cenla Agent]

UHC might buy some of the smaller companies and get even bigger.

I also would not be surprised to see some of the big players like UHC and Humana acquire some smaller companies. There are a number of smaller regional HMO companies around the country as well as the smaller PFFS players. They have both done it before. But the smaller companies that could possibly be acquired will have to stay in the MA game long enough for that to happen.

 

[MedSuppPro]

Last summer I met with a hospital administrator about Coventry. His response was that they just signed a contract with Coventry two weeks before. My point is this – Coventry despite its' issues – isn't going away! They have been contracting in some of my PFFS counties. Sure, some counties will go. But, don't count them out just yet.

 

[MrMack]

Coventry does well in HMO And PPO. As of July 1st, they will not accept any PFFS applications in Iowa. That kind of tells me that PFFS is no longer their focus.