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AGP » Topics » Competition

This excerpt taken from the AGP 10-K filed Feb 22, 2010.
Competition
 
Our principal competition consists of the following:
 
  •  Traditional Fee-for-Service — Original unmanaged provider payment system whereby state governments pay providers directly for services provided to Medicaid and Medicare eligible beneficiaries.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with physicians to provide primary care services to Medicaid recipients, as well as provide limited oversight over other services.
 
  •  Administrative Services Only Health Plans — Health plans that contract with the states to provide administrative services only (“ASO”) for the traditional fee-for-service Medicaid program.
 
  •  Multi-line Commercial Health Plans — National and regional commercial managed care organizations that have Medicaid and Medicare members in addition to members in private commercial plans.


11

 

 
  •  Medicaid Health Plans — Managed care organizations that focus solely on serving people who receive healthcare benefits through Medicaid.
 
  •  Medicare Health Plans — Managed care organizations that focus solely on serving people who receive healthcare benefits through Medicare. These plans also may include Medicare Part D prescription coverage.
 
  •  Medicare Prescription Drug Plans — These plans offer Medicare beneficiaries Part D prescription drug coverage only, while members of these plans receive their medical benefits from Medicare Fee-For-Service.
 
We will continue to face varying levels of competition as we expand in our existing service areas and enter new markets. Changes in the business climate, such as healthcare reform proposals, may cause a number of commercial managed care organizations already in our service areas to decide to enter or exit the publicly sponsored healthcare market. Some of these managed care organizations have substantially larger enrollments, greater financial and other resources and offer a broader scope of products than we do.
 
We compete with other managed care organizations to obtain state contracts, as well as to attract new members and retain existing members. States generally use either a formal procurement process reviewing many bidders or award individual contracts to qualified applicants that apply for entry to the program. In order to be awarded a state contract, state governments consider many factors, which include providing quality care, satisfying financial requirements, demonstrating an ability to deliver services, and establishing networks and infrastructure. People who wish to enroll in a managed healthcare plan or to change healthcare plans typically choose a plan based on the services offered, ease of access to services, a specific provider being part of the network and the availability of supplemental benefits.
 
In addition to competing for members, we compete with other managed care organizations to enter into contracts with independent physicians, physician groups and other providers. We believe the factors that providers consider in deciding whether to contract with us include potential member volume, reimbursement rates, our medical management programs, timeliness of reimbursement and administrative service capabilities.
 
These excerpts taken from the AGP 10-K filed Feb 24, 2009.
Competition
 
Our principal competition consists of the following:
 
  •  Traditional Fee-for-Service — Original unmanaged provider payment system whereby state governments pay providers directly for services provided to Medicaid and Medicare eligible beneficiaries.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with physicians to provide primary care services to Medicaid recipients, as well as provide limited oversight over other services.
 
  •  Administrative Services Only Health Plans — Health plans that contract with the states to provide administrative services only for the traditional fee-for-service Medicaid program.
 
  •  Commercial Health Plans — National and regional commercial managed care organizations that have Medicaid and Medicare members in addition to members in private commercial plans.
 
  •  Medicaid Health Plans — Managed care organizations that focus solely on serving people who receive healthcare benefits through Medicaid.
 
  •  Medicare Health Plans — Managed care organizations that focus on serving people who receive healthcare benefits through Medicare. These plans also may include Medicare Part D prescription coverage.
 
  •  Medicare Prescription Drug Plans — These plans offer Medicare beneficiaries Part D prescription drug coverage only, while members of these plans receive their medical benefits from Medicare Fee-For-Service.
 
We will continue to face varying levels of competition as we expand in our existing service areas and enter new markets. Changes in the business climate, such as healthcare reform proposals, may cause a number of commercial


11

Table of Contents

managed care organizations already in our service areas to decide to enter or exit the publicly sponsored healthcare market.
 
We compete with other managed care organizations to obtain state contracts, as well as to attract new members and to retain existing members. States generally use either a formal procurement process reviewing many bidders or award individual contracts to qualified applicants that apply for entry to the program. In order to be awarded a state contract, state governments consider many factors, which include providing quality care, satisfying financial requirements, demonstrating an ability to deliver services, and establishing networks and infrastructure. People who wish to enroll in a managed healthcare plan or to change healthcare plans typically choose a plan based on the service offered, ease of access to services, a specific provider being part of the network and the availability of supplemental benefits.
 
In addition to competing for members, we compete with other managed care organizations to enter into contracts with independent physicians, physician groups and other providers. We believe the factors that providers consider in deciding whether to contract with us include potential member volume, reimbursement rates, our medical management programs, timeliness of reimbursement and administrative service capabilities.
 
Competition


 



Our principal competition consists of the following:


 












































































  • 
Traditional Fee-for-Service — Original unmanaged
provider payment system whereby state governments pay providers
directly for services provided to Medicaid and Medicare eligible
beneficiaries.
 
  • 
Primary Care Case Management Programs — Programs
established by the states through contracts with physicians to
provide primary care services to Medicaid recipients, as well as
provide limited oversight over other services.
 
  • 
Administrative Services Only Health Plans — Health
plans that contract with the states to provide administrative
services only for the traditional fee-for-service Medicaid
program.
 
  • 
Commercial Health Plans — National and regional
commercial managed care organizations that have Medicaid and
Medicare members in addition to members in private commercial
plans.
 
  • 
Medicaid Health Plans — Managed care organizations
that focus solely on serving people who receive healthcare
benefits through Medicaid.
 
  • 
Medicare Health Plans — Managed care organizations
that focus on serving people who receive healthcare benefits
through Medicare. These plans also may include Medicare
Part D prescription coverage.
 
  • 
Medicare Prescription Drug Plans — These plans offer
Medicare beneficiaries Part D prescription drug coverage
only, while members of these plans receive their medical
benefits from Medicare Fee-For-Service.


 



We will continue to face varying levels of competition as we
expand in our existing service areas and enter new markets.
Changes in the business climate, such as healthcare reform
proposals, may cause a number of commercial





11




Table of Contents






managed care organizations already in our service areas to
decide to enter or exit the publicly sponsored healthcare market.


 



We compete with other managed care organizations to obtain state
contracts, as well as to attract new members and to retain
existing members. States generally use either a formal
procurement process reviewing many bidders or award individual
contracts to qualified applicants that apply for entry to the
program. In order to be awarded a state contract, state
governments consider many factors, which include providing
quality care, satisfying financial requirements, demonstrating
an ability to deliver services, and establishing networks and
infrastructure. People who wish to enroll in a managed
healthcare plan or to change healthcare plans typically choose a
plan based on the service offered, ease of access to services, a
specific provider being part of the network and the availability
of supplemental benefits.


 



In addition to competing for members, we compete with other
managed care organizations to enter into contracts with
independent physicians, physician groups and other providers. We
believe the factors that providers consider in deciding whether
to contract with us include potential member volume,
reimbursement rates, our medical management programs, timeliness
of reimbursement and administrative service capabilities.


 




These excerpts taken from the AGP 10-K filed Feb 22, 2008.
Competition
 
Our principal competitors consist of the following:
 
  •  Traditional Fee-for-Service — Original unmanaged provider payment system whereby state governments pay providers directly for services provided to Medicaid and Medicare Advantage members.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with PCPs to provide primary care services to the Medicaid recipient, as well as provide limited oversight over other services.
 
  •  Commercial HMOs — National and regional commercial managed care organizations that have Medicaid and Medicare members in addition to members in private commercial plans.
 
  •  Medicaid HMOs — Managed care organizations that focus solely on serving people who receive healthcare benefits through Medicaid.
 
  •  Medicare Coordinated Care Plans — Managed care organizations that focus on serving people who receive healthcare benefits through Medicare. These plans also may include Medicare Part D prescription coverage.
 
  •  Private Fee-For-Service Plans — These organizations provide the standard fee-for-service arrangements of Medicare, but are run by private plans and may or may not include a prescription drug plan.
 
  •  Medicare Prescription Drug Plans — These plans offer Medicare beneficiaries Part D prescription drug coverage only, while members of these plans continue to receive their medical benefits from either another Medicare plan or Medicare Fee-For-Service.
 
We will continue to face varying levels of competition as we expand in our existing service areas or enter new markets. Healthcare reform proposals may cause a number of commercial managed care organizations already in our service areas to decide to enter or exit the publicly sponsored healthcare market.
 
We compete with other managed care organizations to obtain state contracts, as well as to attract new members and to retain existing members. States generally use either a formal procurement process reviewing many bidders or award individual contracts to qualified applicants that apply for entry to the program. In order to be awarded a state contract, state governments consider many factors, which include providing quality care, satisfying financial requirements, demonstrating an ability to deliver services, and establishing networks and infrastructure. People who wish to enroll in a managed healthcare plan or to change healthcare plans typically choose a plan based on the service offered, ease of access to services, a specific provider being part of the network and the availability of supplemental benefits.
 
In addition to competing for members, we compete with other managed care organizations to enter into contracts with independent physicians, physician groups and other providers. We believe the factors that providers


11

 

consider in deciding whether to contract with us include potential member volume, reimbursement rates, our medical management programs, timeliness of reimbursement and administrative service capabilities.
 
Competition


 



Our principal competitors consist of the following:


 












































































  • 
Traditional Fee-for-Service — Original unmanaged
provider payment system whereby state governments pay providers
directly for services provided to Medicaid and Medicare
Advantage members.
 
  • 
Primary Care Case Management Programs — Programs
established by the states through contracts with PCPs to provide
primary care services to the Medicaid recipient, as well as
provide limited oversight over other services.
 
  • 
Commercial HMOs — National and regional commercial
managed care organizations that have Medicaid and Medicare
members in addition to members in private commercial plans.
 
  • 
Medicaid HMOs — Managed care organizations that focus
solely on serving people who receive healthcare benefits through
Medicaid.
 
  • 
Medicare Coordinated Care Plans — Managed care
organizations that focus on serving people who receive
healthcare benefits through Medicare. These plans also may
include Medicare Part D prescription coverage.
 
  • 
Private Fee-For-Service Plans — These organizations
provide the standard fee-for-service arrangements of Medicare,
but are run by private plans and may or may not include a
prescription drug plan.
 
  • 
Medicare Prescription Drug Plans — These plans offer
Medicare beneficiaries Part D prescription drug coverage
only, while members of these plans continue to receive their
medical benefits from either another Medicare plan or Medicare
Fee-For-Service.


 



We will continue to face varying levels of competition as we
expand in our existing service areas or enter new markets.
Healthcare reform proposals may cause a number of commercial
managed care organizations already in our service areas to
decide to enter or exit the publicly sponsored healthcare market.


 



We compete with other managed care organizations to obtain state
contracts, as well as to attract new members and to retain
existing members. States generally use either a formal
procurement process reviewing many bidders or award individual
contracts to qualified applicants that apply for entry to the
program. In order to be awarded a state contract, state
governments consider many factors, which include providing
quality care, satisfying financial requirements, demonstrating
an ability to deliver services, and establishing networks and
infrastructure. People who wish to enroll in a managed
healthcare plan or to change healthcare plans typically choose a
plan based on the service offered, ease of access to services, a
specific provider being part of the network and the availability
of supplemental benefits.


 



In addition to competing for members, we compete with other
managed care organizations to enter into contracts with
independent physicians, physician groups and other providers. We
believe the factors that providers





11




 






consider in deciding whether to contract with us include
potential member volume, reimbursement rates, our medical
management programs, timeliness of reimbursement and
administrative service capabilities.


 




This excerpt taken from the AGP 10-K filed Feb 27, 2007.
Competition
 
Our principal competitors for state contracts, members and providers consist of the following types of organizations:
 
  •  Traditional Fee-for-Service — Original unmanaged provider payment system whereby the state governments pay providers directly for services provided to Medicaid members.
 
  •  Primary Care Case Management Programs (PCCMs) — Programs established by the states through contracts with PCPs to provide primary care services to the Medicaid recipient, as well as provide limited oversight over other services.
 
  •  Commercial HMOs — National and regional commercial managed care organizations that have Medicaid and Medicare members in addition to members in private commercial plans.


18

 

 
  •  Medicaid HMOs — Managed care organizations that focus solely on serving people who receive healthcare benefits through Medicaid.
 
  •  Medicare Coordinated Care Plans — Managed care organizations that focus on serving people who receive healthcare benefits through Medicare. These plans also may include Medicare Part D prescription coverage.
 
  •  Private Fee-For-Service Organizations — These organizations provide the standard fee-for-service arrangements of Medicare, but are run by private plans and may or may not include a prescription drug plan.
 
  •  Medicare Part D Plans — These plans offer Medicare beneficiaries prescription drug coverage only, while members of these plans continue to receive their medical benefits from either another Medicare plan or Medicare Fee-For-Service.
 
We will continue to face varying levels of competition as we expand in our existing service areas or enter new markets. Healthcare reform proposals may cause a number of commercial managed care organizations already in our service areas to decide to enter or exit the Medicaid market.
 
We compete with other managed care organizations to obtain state contracts, as well as to attract new members and to retain existing members. States generally use either a formal procurement process reviewing many bidders or award individual contracts to qualified applicants that apply for entry to the program. In order to be awarded a state contract, state governments consider many factors, which include providing quality care, satisfying financial requirements, demonstrating an ability to deliver services, and establishing networks and infrastructure. People who wish to enroll in a managed healthcare plan or to change healthcare plans typically choose a plan based on the service offered, ease of access to services, a specific provider being part of the network and the availability of supplemental benefits.
 
In addition to competing for members, we compete with other managed care organizations to enter into contracts with independent physicians, physician groups and other providers. We believe the factors that providers consider in deciding whether to contract with us include potential member volume, reimbursement rates, our medical management programs, timeliness of reimbursement and administrative service capabilities.
 

EXCERPTS ON THIS PAGE:

10-K
Feb 22, 2010
10-K (2 sections)
Feb 24, 2009
10-K (2 sections)
Feb 22, 2008
10-K
Feb 27, 2007

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