HMSA, Kaiser both post profit in third quarter

Nov. 16--The Hawaii Medical Serv­ice Association, the state's largest health insurer, and Kaiser Permanente Hawaii, the state's largest health maintenance organization, reported profit gains in the third quarter.

HMSA's profit rose to $17.8 million, reversing a $5 million year-earlier loss, due in part to a new, controversial payment model that reimburses doctors a fixed monthly rate per patient.

Kaiser earned $7.7 million, six times more than the year-earlier period, after gaining nearly 6,000 members over the previous year.

HMSA

THIRD-QUARTER NET

$17.8 million

YEAR-EARLIER LOSS

$5 million

KAISER

THIRD-QUARTER NET

$7.7 million

YEAR-EARLIER NET

$1.2 million

HMSA, with 733,289 members, collected $801.4 million in premiums and spent $721.7 million on medical benefits in the quarter ended Sept. 30. By comparison, the insurer reported $748.8 million in revenue and $687.7 million in expenses in the year-earlier period.

Administrative expenses totaled $56.4 million, while fees and taxes related to the Affordable Care Act, or Obamacare, amounted to $3.4 million. That's down from $64.9 million and $5.1 million, respectively.

"Every year we see a rise in the cost of the medical care and prescription drugs that our members use and this year is no different," HMSA President and Chief Executive Officer Michael Gold said in a news release Tuesday. "The good news is that we've been working very closely with Hawaii's providers and employer groups to invest and implement new and innovative programs ... that seem to be paying off."

HMSA posted an operating gain of $19.9 million, reversing an $8.9 million loss in the third quarter of 2015. It also did better with investments, which grew to $6.8 million from $2.5 million a year ago, and reported gains in its reserves, which increased to $372.6 million from $330.6 million.

HMSA said its third-quarter earnings will help offset a first-quarter loss of $30.4 million, resulting from $59.1 million in ACA fees and taxes that go toward federal government subsidies for low-income residents to make insurance more affordable. Health insurers are required to record a year's worth of ACA insurer fees in the first quarter. That means they tend to show a loss in the first quarter and do better over the remainder of the year.

HMSA is making a major change in the way it pays primary care doctors, with a fixed monthly rate for each patient in a practice whether or not the patient visits the doctor. The move is worrisome to some physicians, who say the change could result in less care and hurt patients. HMSA began using the system on a limited basis April 1, and next year will replace the current fee-for-service model, which reimburses doctors based on the number of patient visits and type of service.

Nationally, the move to this new system -- known as "capitated payments" -- is being driven by the Affordable Care Act and the federal Medicare program in an effort to improve the overall health of the population and contain rising medical costs. HMSA also hired registered nurses, social workers and care coordinators to connect with members who need help with finding a specialist, managing medications and making the transition out of hospital care. It also has invested in a Blue Zones project, a community effort to improve the health of residents through healthier living.

Kaiser, with 249,543 members in Hawaii, recorded revenue of $350.2 million, up from $329.5 million, while expenses grew to $343.2 million compared with $329.5 million in the year-earlier period. The HMO reported operating income of $7 million and $700,000 in income from investments.

Kaiser -- both an insurer and medical provider -- said its growth in membership is largely due to having primary care physicians who are taking new patients amid a growing doctor shortage.

"We've got doctors available and open to take new patients. It's been a huge positive, and people really appreciate not having restrictions to get their health care needs met," said Thomas Risse, Kaiser's chief financial officer. "We staff to our membership, and that way we always have enough care for members with top-notch doctors. We built for the growth so we'll always be ahead of the curve. We have capacity, and are ready for the growth that's coming our way."

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