Profits are up at Massachusetts health plans –should you be upset?

Major Massachusetts health insurers all reported higher net income for 2011 than for 2010. The Boston Globe makes the profit numbers sound big, calling them “sharply higher” and reporting that executives collected more pay. And indeed, the profits seem large on an absolute basis: $38.5M for Fallon, $87.6M for Tufts, $93.5M for Harvard Pilgrim and $136.1M for Blue Cross. But actually the dollars are quite small when considered in context.

The $136.1M Blue Cross figure equates to less than $50 per member per year (they have 2.8M members), which is equivalent to about 2 primary care co-pays or about 1 day of what my business pays for a family premium.

CEO compensation is quite restrained as well. The Blue Cross and Fallon CEOs are in the $800,000 range, or about what a moderately successful orthopedist makes. At $1.2M, Harvard Pilgrim’s CEO is getting close to the income of a typical fertility specialist, and at $1.7M the Tufts CEO is at the level of a law firm partner. They are far from the highest paid people in Massachusetts and frankly I don’t see how they could be expected to make less.

With that said, I’m definitely unhappy with the fact that premiums have risen relentlessly. We’ve experienced annual double digit health insurance premium increases since opening our consulting firm 10 years ago. None of our other major expenses have grown at that pace.

Health plans aren’t the biggest cause of cost increases. Pressures come from providers (hospitals and physicians), suppliers (pharma and device), employers (who fail to embrace better managed care) patients (through increased demand) and government (through reimbursement policies and regulations). But for too long health plans were overly complacent about overall costs. Plans are becoming more aggressive about cost control now as they react to demands from customers, regulators and the public. Massachusetts plans have been creative about rolling out new benefit designs and payment plans that preserve quality and control cost.

It’s worth monitoring health plan profits and executive compensation,  but if anything the profit motive for these not-for-profit organizations is too low. Incentives for more radical, impactful change lie in the for-profit sector. Case in point is private equity backed Steward Health, a profit-seeking entity with a big appetite to control costs and generate profits well in excess of what the health plans are pulling in.

High profits are not the enemy of health care cost containment in Massachusetts.

March 2, 2012

3 thoughts on “Profits are up at Massachusetts health plans –should you be upset?”

  1. I came across your blog when googling for cool biotechnology articles – didn’t expect to find this, but enjoyed some of your posts. Keep it up.

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