Aetna And Humana Merger Case Study

The short term decision to start in a limited area and then only grow by one state in 2015 may have served the purpose of limiting risk during a time of uncertainty, however, in the long term, penetrating into new markets may be difficult because individuals currently enrolled are automatically re-enrolled at the end of the period. For Aetna, it may be harder to pull a member from a plan that they currently have. The largest healthcare insurance company UnitedHealth was more conservative than Aetna in the first two years, with participating starting in five states in year one then increasing to 24 in year two. With the addition of UnitedHealth in the same markets as Aetna and the unknown risks associated with new enrollees for the 2015 plan year, the short term could be crucial for Aetna. If Aetna is able to add to 2014’s positive results, and increase membership in markets that UnitedHealth entered, it will go a long way toward their long term goals of increasing membership in the individual and small group sector (Demko, 2014).

Health insurance and the affordable care act is a major topic in the United States today. This being said, there are many questions that run through one’s mind when the topic is discussed. Questions such as, what exactly is health insurance? What is the Aetna-Humana merge, and how beneficial is it? Should healthy citizens help pay for citizens with prior known health issues? Should people with preexisting conditions even have the option to purchase insurance to help cover medical cost? Although the Affordable Care Act has been in effect for a few years now, there are still some problems today the health insurers face because of this law.

The health insurance market in the United States has been anything but competitive since the dawn of it 's existence. In many states, a single health insurance provider dominates the market, with virtually no competition (Holahan and Blumberg). In the past, before 2010, there has been no “marketplace” to compare prices for health insurance, which has contributed to ignorance in terms of finding competitive, lower prices for health insurance. Essentially, health insurance providers have been “price makers” rather than “price takers” because the demand for health insurance is relatively inelastic (as people will always get sick or get

Unfortunately, although antitrust agencies are paying attention to recent court actions against mergers, the FTC investigates only 1-2% of consolidations (McCanne, 2014). It is also important to remember than public payers such as Medicare and Medicaid set prices to physicians and hospitals with no room for negotiating and conversely private insurers may use their market-share leverage to negotiate reimbursements. Integrative care in the form of hospital consolidation has been shown to reduce costs by 10-20% but this cost has not been shown to produce a cost savings to private insurers (Cutler & Morton, 2014).

Healthcare expenditures have more than doubled since 1965. Americans spend over a trillion dollars a year on health care. (2). As of 1996, 110 million Americans were enrolled in HMO's. More than three-fourths of all individuals in HMO's are covered by job-based insurance. More than 13 million Medicaid recipients have been put into managed care plans. Managed care and HMO's have been the subject of many negative stories in the press and are constantly being charged with endangering the health and lives of their enrollees. As a result, congressional hearing, state, and federal regulation, and action by the

Our group defined the success of the merger based on several outcomes. First of all, financial stability within the first two years of the merger; the formation of value-based payment models or other innovative payment structures which appeal to both payers and employers; low employee turnover, at or below the national benchmark; high employee engagement levels based on national benchmarks for the healthcare industry and finally the maintenance of accreditation. Once we defined success, we built out the following steps to work towards these outcomes.

This is where the money is and the growth is. Their consolidation will in essence allow us to lessen the breadth of our dealer coverage and allow us to focus our sales effort in this high growth area.

Aetna responded to North Texas’ demand for $2.7M in underpayments by offering increase to all fixed and percentage commercial rates by 0.8% for one-year. Based on Aetna’s projection of volume for North Texas, it determined that North Texas would recover the full amount of its alleged damages during that period. However, because North Texas believed that Aetna was greatly overstating the likely business volume, the parties were not able to agree on a fixed time period for the temporary rate increase. Ultimately, the parties agreed that the temporary rate increase would last for whatever period of time was necessary for North Texas to actually recover additional payments of $2.7M.

A merger is a partial or total combination of two separate business firms and forming of a new one. There are predominantly two kinds of mergers: partial and complete. Partial merger usually involves the combination of joint ventures and inter-corporate stock purchases. Complete mergers are results in blending of identities and the creation of a single succeeding firm. (Hicks, 2012, p 491). Mergers in the healthcare sector, particularly horizontal hospital mergers wherein two or more hospitals merge into a single corporation, are increasing both in frequency and importance. (Gaughan, 2002). This paper is an attempt to study the impact of the merger of two competing healthcare organization and will also attempt to propose appropriate

Although Anthem is regarded as highly lucrative, the company’s profit margins are extremely low due to the highly competitive and regulated industry. Because there is limited opportunities for market growth, health insurance companies remain competitive by merging with other companies. Anthem is currently in the process of finalizing an acquisition deal with Cigna. This deal has been faced with much scrutiny and pushback from government due to monopoly regulations. If the deal does not go through, Anthem will have to pay a large penalty fee to Cigna. Along with this financial cost, Anthem would also lose time and resources that they have dedicated to this strategy over the past two years. Because of the competitive environment and high stakes, Anthem began cutting costs throughout the company.

When companies combine/merge the whole objective is to gain new opportunities, gain market share, grow the business, to become more innovative and to improve product offerings, utilizing/sharing the existing resources and data. From the case

As a leading insurance company, Aetna’s primary market broadens to reach those who work full time or part time based on hourly wages through its subsidiary company, Strategic Resource Company (SRC) which was bought by Aetna, Inc in 2005 (SRC: Our Mission, 2012). Aetna’s fourth subdivision target market, which is considered the biggest subdivision, is providing insurance to “employers, third-party administrators, commercial insurance companies and other health plans (Aetna Subsidiaries, 2012)”. These latter targets are aimed at through Aetna’s fourth subsidiary Cofinity which includes over 2.5 million members as of 2009 (About Cofinity, 2009). Besides targeting health insurance consumers, Aetna aimed at a target market that excludes health insurance seekers yet includes health care providers. Through a fifth subsidiary, Medicity, Aetna created another target market subdivision where it can provide health information technology in health care facilities such as hospitals and practices (About Medicity, 2012). Finally, Aetna aims at acquiring shareholders and therefore targeted a market of

extracted from the combination of the two businesses. For example, such a consolidation would allow

With each passing day the health care industry is experiencing an increase in participants due to its perfect competition nature. Due to this increase the industry participants, the industry has vicious competition which in effect leads to an increased in the cost of doing business. Smaller companies within the industry are hard hit by this competition due to their limited resources and therefore find it hard to remain relevant within the industry. Due to the looming threat of closure and liquidation, small companies must explore various strategies they may use to remain in operation. On the other hand large hospitals that are looking to eliminate competition and at the same time improve on their market share and in effect their revenues, merge with those that are struggling with low profitability. These mergers are beneficial to the smaller struggling companies since they provide increased savings on company overheads and availability of specialized machinery. Growth is also expected due to the increased market share as well as the good will already established by the large company. Contrary to popular opinion, mergers are not always between a large and a small company. In the healthcare industry two small companies may come together in order to pool their resources together and be in a position to compete against the large companies.

This is a merger that creates market leadership. This is a merger that we can expect to be substantially accretive.