MOH » Topics » Competition

These excerpts taken from the MOH 10-K filed Mar 16, 2009.
Competition
 
We operate in a highly competitive environment.  The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations, new strategic alliances entered into by other managed care organizations, and the entry into the industry of large commercial health plans. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:
 
  •  Multi-Product Managed Care Organizations — National and regional managed care organizations that have Medicaid members in addition to numerous commercial health plan and Medicare members.
 
  •  Medicaid HMOs — National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.
 
  •  Prepaid Health Plans — Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as to provide limited oversight of other services.
 
We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states may present partial barriers to entry into our industry.


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We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.
 
Competition
 
We operate in a highly competitive environment.  The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations, new strategic alliances entered into by other managed care organizations, and the entry into the industry of large commercial health plans. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:
 
  •  Multi-Product Managed Care Organizations — National and regional managed care organizations that have Medicaid members in addition to numerous commercial health plan and Medicare members.
 
  •  Medicaid HMOs — National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.
 
  •  Prepaid Health Plans — Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as to provide limited oversight of other services.
 
We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states may present partial barriers to entry into our industry.


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We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.
 
Competition


 



We operate in a highly competitive
environment.
  The Medicaid managed care industry
is fragmented and currently subject to significant changes as a
result of business consolidations, new strategic alliances
entered into by other managed care organizations, and the entry
into the industry of large commercial health plans. We compete
with a large number of national, regional, and local Medicaid
service providers, principally on the basis of size, location,
and quality of provider network, quality of service, and
reputation. Below is a general description of our principal
competitors for state contracts, members, and providers:


 














































  • 

Multi-Product Managed Care Organizations
— National and regional managed care organizations
that have Medicaid members in addition to numerous commercial
health plan and Medicare members.
 
  • 

Medicaid HMOs — National and regional managed
care organizations that focus principally on providing health
care services to Medicaid beneficiaries, many of which operate
in only one city or state.
 
  • 

Prepaid Health Plans — Health plans that
provide less comprehensive services on an at-risk basis or that
provide benefit packages on a non-risk basis.
 
  • 

Primary Care Case Management Programs
— Programs established by the states through
contracts with primary care providers to provide primary care
services to Medicaid beneficiaries, as well as to provide
limited oversight of other services.


 



We will continue to face varying levels of competition. Health
care reform proposals may cause organizations to enter or exit
the market for government sponsored health programs. However,
the licensing requirements and bidding and contracting
procedures in some states may present partial barriers to entry
into our industry.





10





Table of Contents






We compete for government contracts, renewals of those
government contracts, members, and providers. State agencies
consider many factors in awarding contracts to health plans.
Among such factors are the health plan’s provider network,
medical management, degree of member satisfaction, timeliness of
claims payment, and financial resources. Potential members
typically choose a health plan based on a specific provider
being a part of the network, the quality of care and services
available, accessibility of services, and reputation or name
recognition of the health plan. We believe factors that
providers consider in deciding whether to contract with a health
plan include potential member volume, payment methods,
timeliness and accuracy of claims payment, and administrative
service capabilities.


 




These excerpts taken from the MOH 10-K filed Mar 17, 2008.
Competition
 
We operate in a highly competitive environment. The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations, new strategic alliances entered into by other managed care organizations, and the entry into the industry of large commercial health plans. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:
 
  •  Multi-Product Managed Care Organizations — National and regional managed care organizations that have Medicaid members in addition to numerous commercial health plan and Medicare members.
 
  •  Medicaid HMOs — National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.
 
  •  Prepaid Health Plans — Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.
 
  •  Primary Care Case Management Programs — Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as to provide limited oversight of other services.
 
We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states may present partial barriers to entry into our industry.
 
We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name


9


Table of Contents

recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.
 
Competition


 



We operate in a highly competitive environment. The Medicaid
managed care industry is fragmented and currently subject to
significant changes as a result of business consolidations, new
strategic alliances entered into by other managed care
organizations, and the entry into the industry of large
commercial health plans. We compete with a large number of
national, regional, and local Medicaid service providers,
principally on the basis of size, location, and quality of
provider network, quality of service, and reputation. Below is a
general description of our principal competitors for state
contracts, members, and providers:


 














































  • 

Multi-Product Managed Care Organizations —
National and regional managed care organizations that have
Medicaid members in addition to numerous commercial health plan
and Medicare members.
 
  • 

Medicaid HMOs — National and regional managed
care organizations that focus principally on providing health
care services to Medicaid beneficiaries, many of which operate
in only one city or state.
 
  • 

Prepaid Health Plans — Health plans that
provide less comprehensive services on an at-risk basis or that
provide benefit packages on a non-risk basis.
 
  • 

Primary Care Case Management Programs —
Programs established by the states through contracts with
primary care providers to provide primary care services to
Medicaid beneficiaries, as well as to provide limited oversight
of other services.


 



We will continue to face varying levels of competition. Health
care reform proposals may cause organizations to enter or exit
the market for government sponsored health programs. However,
the licensing requirements and bidding and contracting
procedures in some states may present partial barriers to entry
into our industry.


 



We compete for government contracts, renewals of those
government contracts, members, and providers. State agencies
consider many factors in awarding contracts to health plans.
Among such factors are the health plan’s provider network,
medical management, degree of member satisfaction, timeliness of
claims payment, and financial resources. Potential members
typically choose a health plan based on a specific provider
being a part of the network, the quality of care and services
available, accessibility of services, and reputation or name





9





Table of Contents






recognition of the health plan. We believe factors that
providers consider in deciding whether to contract with a health
plan include potential member volume, payment methods,
timeliness and accuracy of claims payment, and administrative
service capabilities.


 




This excerpt taken from the MOH 10-K filed Mar 14, 2007.

Competition

We operate in a highly competitive environment. The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations, new strategic alliances entered into by other managed care organizations, and the entry into the industry of large commercial health plans. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:

 

   

Multi-Product Managed Care Organizations—National and regional managed care organizations that have Medicaid members in addition to numerous commercial health plan and Medicare members.

 

   

Medicaid HMOs—National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.

 

   

Prepaid Health Plans—Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.

 

   

Primary Care Case Management Programs—Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as to provide limited oversight of other services.

We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states may present partial barriers to entry into our industry.

We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name

 

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Table of Contents

recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.

This excerpt taken from the MOH 10-K filed Mar 15, 2006.

Competition

We operate in a highly competitive environment. The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations and new strategic alliances entered into by other managed care organizations. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:

 

    Multi-Product Managed Care Organizations—National and regional managed care organizations that have Medicaid members in addition to members in Medicare and private commercial plans.

 

    Medicaid HMOs—National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.

 

    Prepaid Health Plans—Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.

 

    Primary Care Case Management Programs—Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as to provide limited oversight of other services.

 

9


Table of Contents

We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states may present partial barriers to entry into our industry.

We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.

This excerpt taken from the MOH 10-K filed Mar 8, 2005.

Competition

 

We operate in a highly competitive environment. The Medicaid managed care industry is fragmented and currently subject to significant changes as a result of business consolidations and new strategic alliances entered into by other managed care organizations. We compete with a large number of national, regional, and local Medicaid service providers, principally on the basis of size, location, and quality of provider network, quality of service, and reputation. Below is a general description of our principal competitors for state contracts, members, and providers:

 

    Multi-Product Managed Care Organizations—National and regional managed care organizations that have Medicaid members in addition to members in Medicare and private commercial plans.

 

    Medicaid HMOs—National and regional managed care organizations that focus principally on providing health care services to Medicaid beneficiaries, many of which operate in only one city or state.

 

    Prepaid Health Plans—Health plans that provide less comprehensive services on an at-risk basis or that provide benefit packages on a non-risk basis.

 

    Primary Care Case Management Programs—Programs established by the states through contracts with primary care providers to provide primary care services to Medicaid beneficiaries, as well as provide limited oversight of other services.

 

8


Table of Contents

We will continue to face varying levels of competition. Health care reform proposals may cause organizations to enter or exit the market for government sponsored health programs. However, the licensing requirements and bidding and contracting procedures in some states present barriers to entry into our industry.

 

We compete for government contracts, renewals of those government contracts, members, and providers. State agencies consider many factors in awarding contracts to health plans. Among such factors are the health plan’s provider network, medical management, degree of member satisfaction, timeliness of claims payment, and financial resources. Potential members typically choose a health plan based on a specific provider being a part of the network, the quality of care and services available, accessibility of services, and reputation or name recognition of the health plan. We believe factors that providers consider in deciding whether to contract with a health plan include potential member volume, payment methods, timeliness and accuracy of claims payment, and administrative service capabilities.

 

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