QUOTE AND NEWS
Jutia Group  Nov 21  Comment 
[Business Wire] - WellPoint, Inc., one of the nation’s largest health benefits companies, today announced it has worked with Critical Measures, a national firm supporting cross-cultural Read more on this. WellPoint Inc. (WLP), valued at...
FierceBiotech  Nov 14  Comment 
Boehringer Ingelheim is working with managed care giant WellPoint in an effort to use real-world data to inform the development of new treatments of atrial fibrillation, keeping up with a sweeping trend in cardiovascular R&D.
Jutia Group  Nov 14  Comment 
[Business Wire] - Boehringer Ingelheim Pharmaceuticals, Inc. , WellPoint and HealthCore, announced today that the companies are commencing a research project to identify and address unmet medi Read more on this. WellPoint Inc. (WLP), with a...
Motley Fool  Nov 9  Comment 
In terms of price and competition, there are big differences from state to state.
Insurance Journal  Nov 3  Comment 
U.S. small businesses are dropping health insurance for their workers, as Obamacare lets them send employees to new marketplaces where they can often get subsidies from the government to buy coverage. WellPoint Inc.’s small business insurance...
Insurance Journal  Oct 30  Comment 
Indianapolis, Ind.-based WellPoint raised its 2014 earnings forecast again and trumped third-quarter expectations as the overhaul of the healthcare system adds millions to the nation’s health insurance rolls, and at a lower cost than was...
Motley Fool  Oct 30  Comment 
WellPoint's third-quarter results suggest momentum may continue to support the share price in 2015.




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Wellpoint Inc. (NYSE: WLP) is the largest managed care company in the United States in terms of enrollment, with 28.4 million Blue Cross and/or Blue Shield enrollees as of end FY2010.[1] With its exclusive license to the Blue Cross Blue Shield brand in its most significant markets and the nation's largest provider network, Wellpoint can compete with other managed care companies by offering nationwide access to care at lower costs than smaller companies. Wellpoint's large size helps it negotiate more favorable reimbursement terms with health care providers like hospitals and physicians, which reduces costs and provides a competitive advantage.[2]

Wellpoint's profitability depends on its ability to accurately predict and manage health care costs for its members by using underwriting criteria and negotiating favorable contracts with providers. Upward trends in medical costs and an aging population adversely affect the company's profits by increasing its expenses.[3] The managed care industry is characterized by consolidation and increasing price sensitivity among consumers.

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Key Trends & Forces

Healthcare reform will impact many aspects of WellPoint's business

With the Patient Protection and Affordable Care Act signed, the much awaited and much debated health reform law was put in force. Several of its provisions will affect Wellpoint and other insurers. The overall effect, however, remains to be seen.[4]

The law includes a large number of health-related provisions to take effect over the next four years, including expanding Medicaid eligibility, subsidizing insurance premiums, providing incentives for businesses to provide health care benefits, prohibiting denial of coverage/claims based on pre-existing conditions, establishing health insurance exchanges, and support for medical research. The costs of these provisions are offset by a variety of taxes, fees, and cost-saving measures, such as new Medicare taxes for high-income brackets, taxes on indoor tanning, cuts to the Medicare Advantage program in favor of traditional Medicare, and fees on medical devices and pharmaceutical companies; there is also a tax penalty for citizens who do not obtain health insurance (unless they are exempt due to low income or other reasons). [5]

The expansion of Medicaid together with the health insurance mandate and premium subsidies are projected expand insurance to 32 million Americans without coverage. Wellpoint, as one of the the largest insurers as well as one of the largest Medicaid contractors, stands to benefit from this.[6]

The law will end the practices of refusing to cover patients with pre-existing conditions. This will likely lead to an increase in premium costs; however, given that the rule applies across the board, it may not hurt insurers’ competitive positioning.

Cuts to Medicare Advantage program reimbursements may hurt Wellpoint, with its 470,000 MA enrollees, in the short term. In the long term, Wellpoint may lose out still more: as MA beneficiary premiums increase to reflect lower government reimbursements, Medicare patients may migrate to less profitable Prescription Drug Plans and opt to receive their medical benefits from the traditional government-run Medicare program.

The health care law will also effectively begin to cap insurance company profits in 2011. Insurers will be required to spend 85% of large-group and 80% of small-group plan premiums on medical costs, or else improve health-care quality or return the difference to customers in the form of a rebate. However, Wellpoint reportedly reclassified certain administrative expenses--$500 million dollars worth--in a way that increased its medical loss ratio. In January, Wellpoint began costs such as as nurse hotlines, "medical management," and "clinical health policy," under medical benefits. Thus, the impact remains to be seen.

Rising Unemployment in has led to a Decrease in Health Care Enrollment with Subsequent Losses in Membership.

Unemployment rates are up to current rates reaching at around 9-10% levels -- the highest it has been in a quarter-century.[7] As unemployment increases, laid off workers lose access to employer-based health care. This subsequent decrease in health care expenditure impacts health care providers and the health care industry at large by decreasing their membership.[8] As a result, health insurers has seen a decrease in growth in net income and operating earnings, especially in its health care market.

Rising healthcare costs put pressure on earnings

Rising healthcare cost is a major concern for health insurance companies, and trends show healthcare costs for U.S. businesses rising 9%. These rising medical costs combine with the recession and increased unemployment to create a "tug-of-war" between the need to raise premiums and the downtrend on enrollment and willingness of consumers and business to pay high premiums.[9] These competing pressures are having the overall effect of lowering all health insurers' revenues and margins. Health insurer's ability to mitigate the negative effects of rising healthcare and unemployment will be critical to it's ability to maintain strong earnings and compete in the health insurance industry.

Competition

As the nation's largest managed care organization by medical enrollment, Wellpoint is able to use its size and nationwide presence to negotiate more favorable contracts with health care providers like physicians and hospitals, thereby reducing the amount it spends on health care benefits for members.

Consumers have favored health insurance plans offering larger networks and greater member choice relating to coverage and physicians. The BlueCard program, in which each of the 39 independent Blue Cross Blue Shield licensed companies participates, lets any BCBS licensed company take advantage of any other BCBS licensed company's provider networks and discounts when a member works or travels outside of the state in which the policy is written. The program provides Wellpoint and other BCBS licensed companies with a competitive advantage, especially when competing for the business of employers with offices around the country[10]

Wellpoint enjoys the number one market share in almost all of the 14 states in which it operates using the Blue Cross Blue Shield License. Among these Blue states, the company has a 30 percent or greater share of the market in four of them and another four states in which it has greater than 40 percent market share.[11]

Good post. I often act for tnanets in disrepair cases and landlords' disclosure is frequently very poor, with obvious holes and absences messages referred to in disclosed documents, tenders or quotes referred to in repair records, email records where we know email was used etc. etc. are often missing, without explanation. It just invites an application for specific disclosure couched as an unless' order. When I am acting for a tenant,I love it, but from the landlord's perspective it is so much better to have given full disclosure to begin with

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