Table II.1. Overview of Firms Involved in the Collaborative

Participating Firms

Scale and Location

Primary Products

National Firms

Aetna

Over 13 million covered lives that are served by 6 regions.

Primarily commercial; mix of HMOs and PPOs; serves large national accounts, among others, and has some Medicare business.

Cigna

Approximately 13 million covered lives in at least 42 states and DC.

Primarily commercial; mix of HMO and PPO products; serves large national accounts, among others.

Kaiser Permanente

Approximately 8.5 million covered lives, served mainly through integrated care system in 8 regions.

Primarily commercial with HMO products; Medicare products, particularly for those "aging in."

United Healthcare

Over 18 million covered lives; operates through related businesses for the commercial market (United Healthcare), Seniors (Ovations), Medicaid (Americhoice), and others.

Primarily commercial, although the firm offers a mix of products that address Medicare, Medicaid, and other market sectors. Recent merger with PacifiCare has enlarged its role in Medicare.

WellPoint

Approximately 28 million covered lives after the recent merger with Anthem. Affiliated with Blue Cross-Blue Shield (BC-BS) and offers products in 13 states.

Primarily commercial through a range of HMO, PPO, and other products. Also serves Medicare and Medicaid.

Regional Firms

Harvard Pilgrim Healthcare

About 900,000 covered lives in nonprofit health plan based in Massachusetts, Maine, and New Hampshire.

Primarily commercial with range of HMO, PPO, and other products, and some Medicare business.

HealthPartners

Over 630,000 covered lives in nonprofit health plan serving Minnesota and western Wisconsin. Has a staff model HMO affiliate (Group Health).

Primarily commercial in a variety of HMO, PPO products, and some Medicare business.

Highmark Inc.

Over 4.1 million covered lives in an independent, nonprofit BC-BS licensed plan serving western and central Pennsylvania.

Primarily commercial with some Medicare supplemental products (is affiliated with a Medicaid plan).

Molina Healthcare

Over 500,000 covered lives in 6 states in the west and north central United States. Headquartered in California. Includes a staff model unit.

Medicaid, SCHIP, and related programs.

Source:   MPR summary based on publicly available information, 2005.

HMO = Health Maintenance Organization; PPO  = Preferred Provider Organization; SCHIP = State Children's Health Insurance Program.

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