Delaware
|
1-31719
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13-4204626
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||
(State of incorporation)
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(Commission File Number)
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(I.R.S. Employer Identification Number)
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Item 2.02. | Results of Operations and Financial Condition. |
Item 9.01. | Financial Statements and Exhibits. |
(d) | Exhibits: |
Exhibit | |
No. | Description |
99.1 | Press release of Molina Healthcare, Inc. issued April 25, 2013, as to financial results for the first quarter ended March 31, 2013. |
MOLINA HEALTHCARE, INC.
|
||||
Date: April 25, 2013
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By: /s/ Jeff D. Barlow
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|||
Jeff D. Barlow
Sr. Vice President – General Counsel, and Secretary
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Exhibit | |
No. | Description |
99.1 | Press release of Molina Healthcare, Inc. issued April 25, 2013, as to financial results for the first quarter ended March 31, 2013. |
●
|
Full year 2013 guidance increased to $1.55 per diluted share
|
●
|
Earnings per diluted share for first quarter 2013 of $0.64, up from $0.39 in first quarter of 2012
|
●
|
Operating income doubles from 2012, increasing by $34 million
|
●
|
Quarterly premium revenues of $1.5 billion, up 17% over 2012
|
●
|
The recognition of approximately $21 million of premium rate changes at the California health plan. Approximately $19 million of the premium revenue related to 2012 and 2011. Net of related expenses, the rate increases resulted in an increase of approximately $19 million to pretax income; $18 million (approximately $0.24 per diluted share) of which related to 2012 and 2011. The adjustment to premium rates resulted from the receipt of new rate sheets from the state of California that restored the rates that had existed prior to the cuts that had been taken effective July 1, 2011, and a modest increase to rates for the Company’s aged, blind, or disabled, or ABD, membership retroactive to July 1, 2011. The new premium rates are expected to increase premium revenue at the California health plan going forward by approximately $400,000 per month;
|
●
|
The recognition of approximately $6 million (approximately $0.08 per diluted share) of performance revenue at the Texas health plan related to 2012. The Texas health plan recently received notice from the Texas Department of Health and Human Services that a specific measure is being removed from the calculation of performance revenue for all contracted health plans for 2012. As of December 31, 2012, the Texas health plan had not recognized approximately $6 million of revenue related to this performance measure;
|
●
|
Flat inpatient utilization compared with the first quarter of 2012;
|
●
|
Improved performance at the Florida, Texas, Ohio and Wisconsin health plans; and
|
●
|
The immediate recognition in interest expense of approximately $6 million (approximately $0.08 per diluted share) of debt issuance fees related to the Company’s issuance of $550 million of 1.125% cash convertible senior notes (the 1.125% Notes) in February 2013. The remainder of the fees associated with that issuance will be expensed over the seven-year life of the 1.125% Notes.
|
Premium Revenue
|
Medical Care Costs
|
●
|
The first quarters of 2013 and 2012 are not meaningfully comparable. The state of Texas expanded Medicaid managed care into new regions effective March 1, 2012. Additionally, the state extended inpatient facility and pharmacy benefits into Medicaid managed care on that date. The result of these actions was to dramatically increase the Texas health plan’s revenue and medical costs between the first quarters of 2012 and 2013.
|
●
|
The Texas health plan received a 4% rate increase (adding about $4 million to monthly revenue) effective September 1, 2012.
|
●
|
Certain out-of-period adjustments artificially lowered the medical care ratio for the Texas health plan in the first quarter of 2013. Absent the previously described $6 million out-of-period benefit related to 2012 performance revenue and a $13.5 million benefit from favorable development of the claims liability established for the health plan at December 31, 2012, the Texas health plan’s medical care ratio for the first quarter of 2013 would have been approximately 86.6% rather than the reported medical care ratio of 80.9%.
|
●
|
While management continues to work to improve the financial performance of the Texas health plan, management also believes that increased payments to certain providers are necessary. Specifically, the health plan intends to increase provider reimbursement for personal attendant services and day activity and health services effective July 1, 2013. The Company anticipates that this increase in provider payments alone will add approximately $10 million to medical expense in the second half of 2013.
|
Three Months Ended March 31,
|
||||||||
2013
|
2012
|
|||||||
(In thousands)
|
||||||||
Net income
|
$ | 29,915 | $ | 18,089 | ||||
Add back:
|
||||||||
Depreciation and amortization reported in the consolidated statements of cash flows
|
21,799 | 18,339 | ||||||
Interest expense
|
13,037 | 4,298 | ||||||
Income tax expense
|
24,270 | 11,033 | ||||||
EBITDA
|
$ | 89,021 | $ | 51,759 |
(1)
|
GAAP stands for U.S. generally accepted accounting principles.
|
(2)
|
EBITDA is not prepared in conformity with GAAP because it excludes depreciation and amortization, as well as interest expense and income tax expense. This non-GAAP financial measure should not be considered as an alternative to the GAAP measures of net income, operating income, operating margin, or cash provided by operating activities, nor should EBITDA be considered in isolation from these GAAP measures of operating performance. Management uses EBITDA as a supplemental metric in evaluating the Company’s financial performance, in evaluating financing and business development decisions, and in forecasting and analyzing future periods. For these reasons, management believes that EBITDA is a useful supplemental measure to investors in evaluating the Company’s performance and the performance of other companies in the Company’s industry.
|
●
|
The Company expects to increase payments to certain providers of personal attendant services and day activity and health services in Texas, effective July 1, 2013. The Company expects that this action will increase expense during the second half of 2013 by approximately $10 million.
|
●
|
In March 2013, the Company adopted a performance-based equity compensation program that is expected to increase previously anticipated equity compensation expense for all of 2013 by approximately $13 million. The Company believes that performance-based equity grants align compensation with the long-term interest of investors.
|
●
|
uncertainties associated with the implementation of the Affordable Care Act, including the impact of the health insurance industry excise tax, the expansion of Medicaid eligibility in participating states to previously uninsured populations unfamiliar with managed care, the implementation of state insurance exchanges currently expected to become operational by October 1, 2013, the effect of various implementing regulations, and uncertainties regarding the impact of other federal or state health care and insurance reform measures, including the duals demonstration programs in California, Ohio, Michigan, and Texas;
|
●
|
the success of our medical cost containment initiatives in Texas, and other risks associated with the expansion of our Texas health plan’s service areas in 2012;
|
●
|
significant budget pressures on state governments and their potential inability to maintain current rates, to implement expected rate increases, or to maintain existing benefit packages or membership eligibility thresholds or criteria;
|
●
|
management of our medical costs, including seasonal flu patterns and rates of utilization that are consistent with our expectations and our accruals for incurred but not reported medical costs;
|
●
|
the success of our efforts to retain existing government contracts and to obtain new government contracts in connection with state requests for proposals (RFPs) in both existing and new states, and our ability to increase our revenues consistent with our expectations;
|
●
|
accurate estimation of incurred but not reported medical costs across our health plans;
|
●
|
risks associated with the continued growth in new Medicaid and Medicare enrollees, and the development of actuarially sound rates with respect to such new enrollees, including duals;
|
●
|
retroactive adjustments to premium revenue or accounting estimates which require adjustment based upon subsequent developments, including Medicaid pharmaceutical rebates;
|
●
|
continuation and renewal of the government contracts of both our health plans and Molina Medicaid Solutions and the terms under which such contracts are renewed;
|
●
|
government audits and reviews, and any enrollment freeze or monitoring program that may result therefrom;
|
●
|
changes with respect to our provider contracts and the loss of providers;
|
●
|
the establishment of a federal or state medical cost expenditure floor as a percentage of the premiums we receive, and the interpretation and implementation of medical cost expenditure floors, administrative cost and profit ceilings, and profit sharing arrangements;
|
●
|
interpretation and implementation of at-risk premium rules regarding the achievement of certain quality measures;
|
●
|
approval by state regulators of dividends and distributions by our health plan subsidiaries;
|
●
|
changes in funding under our contracts as a result of regulatory changes, programmatic adjustments, or other reforms;
|
●
|
high dollar claims related to catastrophic illness;
|
●
|
the favorable resolution of litigation, arbitration, or administrative proceedings, including our pending litigation against the state of California related to rates paid to our California plan in earlier years that were not actuarially sound;
|
●
|
recognition of revenue retroactive to July 1, 2011, related to the reversal of rate cuts enacted under California Assembly Bill 97 and a rate increase for seniors and persons with disabilities;
|
●
|
restrictions and covenants in any future credit facility;
|
●
|
the relatively small number of states in which we operate health plans;
|
●
|
the availability of adequate financing to fund and capitalize our expansion and growth activities and to meet our liquidity needs, including the interest expense and other costs associated with such financing;
|
●
|
a state’s failure to renew its federal Medicaid waiver;
|
●
|
inadvertent unauthorized disclosure of protected health information;
|
●
|
changes generally affecting the managed care or Medicaid management information systems industries;
|
●
|
increases in government surcharges, taxes, and assessments;
|
●
|
changes in general economic conditions, including unemployment rates; and
|
●
|
increasing consolidation in the Medicaid industry;
|
Three Months Ended March 31,
|
||||||||
2013
|
2012
|
|||||||
(Amounts in thousands,
except net income per share)
|
||||||||
Revenue:
|
||||||||
Premium revenue
|
$ | 1,497,608 | $ | 1,283,220 | ||||
Premium tax
|
37,000 | 42,186 | ||||||
Service revenue
|
49,756 | 42,205 | ||||||
Investment income
|
1,529 | 1,717 | ||||||
Rental and other income
|
4,694 | 4,259 | ||||||
Total revenue
|
1,590,587 | 1,373,587 | ||||||
Expenses:
|
||||||||
Medical care costs
|
1,288,754 | 1,130,988 | ||||||
Cost of service revenue
|
39,770 | 30,494 | ||||||
General and administrative expenses
|
141,407 | 121,474 | ||||||
Premium tax expenses
|
37,000 | 42,186 | ||||||
Depreciation and amortization
|
16,565 | 15,025 | ||||||
Total expenses
|
1,523,496 | 1,340,167 | ||||||
Operating income
|
67,091 | 33,420 | ||||||
Other expenses (income):
|
||||||||
Interest expense
|
13,037 | 4,298 | ||||||
Other income
|
(131 | ) | – | |||||
Total other expenses
|
12,906 | 4,298 | ||||||
Income before income taxes
|
54,185 | 29,122 | ||||||
Income tax expense
|
24,270 | 11,033 | ||||||
Net income
|
$ | 29,915 | $ | 18,089 | ||||
Net income per share:
|
||||||||
Basic
|
$ | 0.65 | $ | 0.39 | ||||
Diluted
|
$ | 0.64 | $ | 0.39 | ||||
Weighted average shares outstanding:
|
||||||||
Basic
|
45,981 | 45,998 | ||||||
Diluted
|
46,443 | 46,887 | ||||||
Operating Statistics:
|
||||||||
Medical care ratio (1)
|
86.1 | % | 88.1 | % | ||||
Service revenue ratio (2)
|
79.9 | % | 72.3 | % | ||||
General and administrative expense ratio (3)
|
8.9 | % | 8.8 | % | ||||
Premium tax ratio (1)
|
2.4 | % | 3.2 | % | ||||
Effective tax rate
|
44.8 | % | 37.9 | % |
(1)
|
Medical care ratio represents medical care costs as a percentage of premium revenue, net of premium taxes; premium tax ratio represents premium taxes as a percentage of premium revenue.
|
(2)
|
Service revenue ratio represents cost of service revenue as a percentage of service revenue.
|
(3)
|
Computed as a percentage of total revenue.
|
(Unaudited)
|
||||||||
March 31,
2013
|
Dec. 31,
2012
|
|||||||
(Amounts in thousands,
except per share data)
|
||||||||
ASSETS
|
||||||||
Current assets:
|
||||||||
Cash and cash equivalents
|
$ | 1,169,511 | $ | 795,770 | ||||
Investments
|
341,946 | 342,845 | ||||||
Receivables
|
150,251 | 149,682 | ||||||
Deferred income taxes
|
25,753 | 32,443 | ||||||
Prepaid expenses and other current assets
|
39,577 | 28,386 | ||||||
Total current assets
|
1,727,038 | 1,349,126 | ||||||
Property, equipment, and capitalized software, net
|
237,735 | 221,443 | ||||||
Deferred contract costs
|
53,813 | 58,313 | ||||||
Intangible assets, net
|
72,864 | 77,711 | ||||||
Goodwill and indefinite-lived intangible assets
|
151,088 | 151,088 | ||||||
Auction rate securities
|
13,600 | 13,419 | ||||||
Restricted investments
|
55,117 | 44,101 | ||||||
Derivative asset
|
147,385 | – | ||||||
Other assets
|
29,449 | 19,621 | ||||||
$ | 2,488,089 | $ | 1,934,822 | |||||
LIABILITIES AND STOCKHOLDERS’ EQUITY
|
||||||||
Current liabilities:
|
||||||||
Medical claims and benefits payable
|
$ | 491,145 | $ | 494,530 | ||||
Accounts payable and accrued liabilities
|
159,986 | 184,034 | ||||||
Deferred revenue
|
135,804 | 141,798 | ||||||
Income taxes payable
|
14,944 | 6,520 | ||||||
Current maturities of long-term debt
|
1,167 | 1,155 | ||||||
Total current liabilities
|
803,046 | 828,037 | ||||||
Long-term debt
|
642,005 | 261,784 | ||||||
Deferred income taxes
|
31,353 | 37,900 | ||||||
Derivative liabilities
|
223,647 | 1,307 | ||||||
Other long-term liabilities
|
23,839 | 23,480 | ||||||
Total liabilities
|
1,723,890 | 1,152,508 | ||||||
Stockholders’ equity:
|
||||||||
Common stock, $0.001 par value; 80,000 shares authorized;
outstanding: 45,415 shares at March 31, 2013 and 46,762 shares
at December 31, 2012
|
45 | 47 | ||||||
Preferred stock, $0.001 par value; 20,000 shares authorized,
no shares issued and outstanding
|
– | – | ||||||
Additional paid-in capital
|
234,236 | 285,524 | ||||||
Accumulated other comprehensive loss
|
(197 | ) | (457 | ) | ||||
Treasury stock, at cost; 111 shares at December 31, 2012
|
– | (3,000 | ) | |||||
Retained earnings
|
530,115 | 500,200 | ||||||
Total stockholders’ equity
|
764,199 | 782,314 | ||||||
$ | 2,488,089 | $ | 1,934,822 |
Three Months Ended
March 31,
|
||||||||
2013
|
2012
|
|||||||
(Amounts in thousands)
|
||||||||
Operating activities:
|
||||||||
Net income
|
$ | 29,915 | $ | 18,089 | ||||
Adjustments to reconcile net income to net cash provided
by operating activities:
|
||||||||
Depreciation and amortization
|
21,799 | 18,339 | ||||||
Deferred income taxes
|
(16 | ) | 8,263 | |||||
Stock-based compensation
|
4,421 | 4,666 | ||||||
Gain on sale of subsidiary
|
– | (1,747 | ) | |||||
Non-cash interest on convertible senior notes
|
3,723 | 1,443 | ||||||
Change in fair value of derivatives
|
(119 | ) | – | |||||
Amortization of premium/discount on investments
|
1,502 | 1,850 | ||||||
Amortization of deferred financing costs
|
1,248 | 258 | ||||||
Tax deficiency from employee stock compensation
|
(42 | ) | (31 | ) | ||||
Changes in operating assets and liabilities:
|
||||||||
Receivables
|
(569 | ) | (54,356 | ) | ||||
Prepaid expenses and other current assets
|
(8,956 | ) | (5,640 | ) | ||||
Medical claims and benefits payable
|
(3,385 | ) | 53,357 | |||||
Accounts payable and accrued liabilities
|
(31,847 | ) | (34,796 | ) | ||||
Deferred revenue
|
(5,994 | ) | 44,543 | |||||
Income taxes
|
8,424 | (3,663 | ) | |||||
Net cash provided by operating activities
|
20,104 | 50,575 | ||||||
Investing activities:
|
||||||||
Purchases of equipment
|
(11,167 | ) | (13,505 | ) | ||||
Purchases of investments
|
(76,012 | ) | (88,199 | ) | ||||
Sales and maturities of investments
|
75,647 | 65,767 | ||||||
Proceeds from sale of subsidiary, net of cash surrendered
|
– | 9,162 | ||||||
Decrease (increase) in deferred contract costs
|
1,756 | (12,993 | ) | |||||
Increase in restricted investments
|
(11,016 | ) | (493 | ) | ||||
Change in other noncurrent assets and liabilities
|
(408 | ) | (2,457 | ) | ||||
Net cash used in investing activities
|
(21,200 | ) | (42,718 | ) | ||||
Financing activities:
|
||||||||
Proceeds from issuance of 1.125% Notes, net of deferred issuance costs
|
537,973 | – | ||||||
Purchase of call option relating to 1.125% Notes
|
(149,331 | ) | – | |||||
Proceeds from issuance of warrants
|
75,074 | – | ||||||
Treasury stock purchases
|
(50,000 | ) | – | |||||
Repayment of amounts borrowed under credit facility
|
(40,000 | ) | – | |||||
Amount borrowed under credit facility
|
– | 10,000 | ||||||
Principal payments on term loan
|
(291 | ) | (301 | ) | ||||
Proceeds from employee stock plans
|
235 | 2,748 | ||||||
Excess tax benefits from employee stock compensation
|
1,177 | 3,592 | ||||||
Net cash provided by financing activities
|
374,837 | 16,039 | ||||||
Net increase in cash and cash equivalents
|
373,741 | 23,896 | ||||||
Cash and cash equivalents at beginning of period
|
795,770 | 493,827 | ||||||
Cash and cash equivalents at end of period
|
$ | 1,169,511 | $ | 517,723 |
|
●
|
Amortization of purchased intangibles relating to customer relationships is reported as amortization within the heading “Depreciation and Amortization;”
|
|
●
|
Amortization of purchased intangibles relating to contract backlog is recorded as a reduction of “Service Revenue;” and
|
|
●
|
Depreciation is recorded within the heading “Cost of Service Revenue.”
|
Three Months Ended March 31,
|
||||||||||||||||
2013
|
2012
|
|||||||||||||||
Amount
|
% of Total
Revenue
|
Amount
|
% of Total
Revenue
|
|||||||||||||
(Dollar amounts in thousands)
|
||||||||||||||||
Depreciation and amortization of
capitalized software
|
$ | 12,447 | 0.8 | % | $ | 9,472 | 0.7 | % | ||||||||
Amortization of intangible assets
|
4,118 | 0.3 | 5,553 | 0.4 | ||||||||||||
Depreciation and amortization reported
as such in the consolidated statements
of income
|
16,565 | 1.1 | 15,025 | 1.1 | ||||||||||||
Amortization recorded as reduction
of service revenue
|
729 | – | 153 | – | ||||||||||||
Amortization of capitalized software recorded as cost of service revenue
|
4,505 | 0.3 | 3,161 | 0.2 | ||||||||||||
Total
|
$ | 21,799 | 1.4 | % | $ | 18,339 | 1.3 | % |
March 31,
2013
|
Dec. 31,
2012
|
March 31,
2012
|
||||||||||
Total Ending Membership by Health Plan:
|
||||||||||||
California
|
332,000 | 336,000 | 351,000 | |||||||||
Florida
|
75,000 | 73,000 | 69,000 | |||||||||
Michigan
|
217,000 | 220,000 | 222,000 | |||||||||
Missouri (1)
|
– | – | 81,000 | |||||||||
New Mexico
|
91,000 | 91,000 | 89,000 | |||||||||
Ohio
|
242,000 | 244,000 | 249,000 | |||||||||
Texas
|
274,000 | 282,000 | 280,000 | |||||||||
Utah
|
87,000 | 87,000 | 86,000 | |||||||||
Washington
|
416,000 | 418,000 | 356,000 | |||||||||
Wisconsin
|
86,000 | 46,000 | 42,000 | |||||||||
Total
|
1,820,000 | 1,797,000 | 1,825,000 | |||||||||
Total Ending Membership by State for the
Medicare Advantage Plans:
|
||||||||||||
California
|
7,700 | 7,700 | 6,900 | |||||||||
Florida
|
600 | 900 | 800 | |||||||||
Michigan
|
9,200 | 9,700 | 8,500 | |||||||||
New Mexico
|
900 | 900 | 900 | |||||||||
Ohio
|
300 | 300 | 200 | |||||||||
Texas
|
1,900 | 1,500 | 800 | |||||||||
Utah
|
7,600 | 8,200 | 8,100 | |||||||||
Washington
|
6,100 | 6,500 | 5,200 | |||||||||
Total
|
34,300 | 35,700 | 31,400 | |||||||||
Total Ending Membership by State for the
Aged, Blind or Disabled Population:
|
||||||||||||
California
|
44,600 | 44,700 | 37,300 | |||||||||
Florida
|
10,400 | 10,300 | 10,500 | |||||||||
Michigan
|
44,000 | 41,900 | 38,800 | |||||||||
New Mexico
|
5,800 | 5,700 | 5,600 | |||||||||
Ohio
|
28,200 | 28,200 | 29,700 | |||||||||
Texas
|
94,200 | 95,900 | 109,000 | |||||||||
Utah
|
9,200 | 9,000 | 8,700 | |||||||||
Washington
|
31,300 | 30,000 | 4,700 | |||||||||
Wisconsin
|
1,600 | 1,700 | 1,700 | |||||||||
Total
|
269,300 | 267,400 | 246,000 |
(1)
|
The Company’s contract with the state of Missouri expired without renewal on June 30, 2012.
|
Three Months Ended March 31, 2013
|
||||||||||||||||||||||||
Member
Months (1)
|
Premium Revenue
|
Medical Care Costs
|
MCR (4)
|
|||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
|||||||||||||||||||||
California
|
1,001 | $ | 187,788 | $ | 187.55 | $ | 159,763 | $ | 159.56 | 85.1 | % | |||||||||||||
Florida
|
223 | 58,164 | 260.13 | 49,404 | 220.95 | 84.9 | ||||||||||||||||||
Michigan
|
652 | 166,557 | 255.52 | 146,748 | 225.13 | 88.1 | ||||||||||||||||||
New Mexico
|
274 | 84,000 | 306.97 | 72,149 | 263.66 | 85.9 | ||||||||||||||||||
Ohio
|
726 | 268,808 | 370.44 | 227,454 | 313.45 | 84.6 | ||||||||||||||||||
Texas
|
832 | 329,451 | 395.96 | 266,449 | 320.24 | 80.9 | ||||||||||||||||||
Utah
|
259 | 74,956 | 289.59 | 65,029 | 251.24 | 86.8 | ||||||||||||||||||
Washington
|
1,250 | 298,286 | 238.70 | 261,397 | 209.18 | 87.6 | ||||||||||||||||||
Wisconsin
|
200 | 27,124 | 135.53 | 23,664 | 118.24 | 87.2 | ||||||||||||||||||
Other (2) (3)
|
– | 2,474 | – | 16,697 | – | – | ||||||||||||||||||
5,417 | $ | 1,497,608 | $ | 276.49 | $ | 1,288,754 | $ | 237.93 | 86.1 | % |
Three Months Ended March 31, 2012
|
||||||||||||||||||||||||
Member
Months (1)
|
Premium Revenue
|
Medical Care Costs
|
MCR (4)
|
|||||||||||||||||||||
Total
|
PMPM
|
Total
|
PMPM
|
|||||||||||||||||||||
California
|
1,059 | $ | 159,376 | $ | 150.47 | $ | 141,349 | $ | 133.45 | 88.7 | % | |||||||||||||
Florida
|
208 | 56,183 | 269.84 | 49,569 | 238.07 | 88.2 | ||||||||||||||||||
Michigan
|
665 | 159,866 | 240.40 | 134,211 | 201.82 | 84.0 | ||||||||||||||||||
Missouri (2)
|
243 | 56,613 | 233.32 | 53,120 | 218.93 | 93.8 | ||||||||||||||||||
New Mexico
|
266 | 79,273 | 298.28 | 67,111 | 252.52 | 84.7 | ||||||||||||||||||
Ohio
|
746 | 270,672 | 363.07 | 236,701 | 317.51 | 87.4 | ||||||||||||||||||
Texas
|
592 | 195,039 | 329.21 | 180,089 | 303.97 | 92.3 | ||||||||||||||||||
Utah
|
252 | 75,138 | 297.59 | 57,881 | 229.24 | 77.0 | ||||||||||||||||||
Washington
|
1,067 | 211,794 | 198.50 | 181,425 | 170.04 | 85.7 | ||||||||||||||||||
Wisconsin
|
125 | 17,142 | 136.97 | 16,886 | 134.92 | 98.5 | ||||||||||||||||||
Other (3)
|
– | 2,124 | – | 12,646 | – | – | ||||||||||||||||||
5,223 | $ | 1,283,220 | $ | 245.67 | $ | 1,130,988 | $ | 216.53 | 88.1 | % |
(1)
|
A member month is defined as the aggregate of each month’s ending membership for the period presented.
|
(2)
|
The Company’s contract with the state of Missouri expired without renewal on June 30, 2012. The Missouri health plan’s claims run-out activity subsequent to June 30, 2012, is reported in “Other.”
|
(3)
|
“Other” medical care costs also include medically related administrative costs at the parent company.
|
(4)
|
The MCR represents medical costs as a percentage of premium revenues, where premium revenue is reduced by premium tax expense.
|
Three Months Ended March 31,
|
||||||||||||||||||||||||
2013
|
2012
|
|||||||||||||||||||||||
Amount
|
PMPM
|
% of Total
|
Amount
|
PMPM
|
% of Total
|
|||||||||||||||||||
Fee-for-service
|
$ | 867,648 | $ | 160.18 | 67.3 | % | $ | 777,267 | $ | 148.81 | 68.7 | % | ||||||||||||
Pharmacy
|
231,838 | 42.80 | 18.0 | 173,237 | 33.17 | 15.3 | ||||||||||||||||||
Capitation
|
140,324 | 25.91 | 10.9 | 136,038 | 26.04 | 12.0 | ||||||||||||||||||
Other
|
48,944 | 9.04 | 3.8 | 44,446 | 8.51 | 4.0 | ||||||||||||||||||
Total
|
$ | 1,288,754 | $ | 237.93 | 100.0 | % | $ | 1,130,988 | $ | 216.53 | 100.0 | % |
March 31,
2013
|
Dec. 31,
2012
|
March 31,
2012
|
||||||||||
Fee-for-service claims incurred but not paid (IBNP)
|
$ | 378,926 | $ | 377,614 | $ | 347,307 | ||||||
Capitation payable
|
45,048 | 49,066 | 37,289 | |||||||||
Pharmacy
|
39,495 | 38,992 | 38,443 | |||||||||
Other
|
27,676 | 28,858 | 32,794 | |||||||||
$ | 491,145 | $ | 494,530 | $ | 455,833 |
Three Months Ended
March 31,
|
Year Ended
Dec. 31,
|
|||||||||||
2013
|
2012
|
2012
|
||||||||||
(Dollars in thousands,
except per-member amounts)
|
||||||||||||
Balances at beginning of period
|
$ | 494,530 | $ | 402,476 | $ | 402,476 | ||||||
Components of medical care costs related to:
|
||||||||||||
Current period
|
1,347,181 | 1,167,580 | 5,136,055 | |||||||||
Prior periods
|
(58,427 | ) | (36,592 | ) | (39,295 | ) | ||||||
Total medical care costs
|
1,288,754 | 1,130,988 | 5,096,760 | |||||||||
Payments for medical care costs related to:
|
||||||||||||
Current period
|
916,426 | 750,994 | 4,649,363 | |||||||||
Prior periods
|
375,713 | 326,637 | 355,343 | |||||||||
Total paid
|
1,292,139 | 1,077,631 | 5,004,706 | |||||||||
Balances at end of period
|
$ | 491,145 | $ | 455,833 | $ | 494,530 | ||||||
Benefit from prior period as a percentage of:
|
||||||||||||
Balance at beginning of period
|
11.8 | % | 9.1 | % | 9.8 | % | ||||||
Premium revenue
|
3.8 | % | 2.8 | % | 0.7 | % | ||||||
Total medical care costs
|
4.5 | % | 3.2 | % | 0.8 | % | ||||||
Claims Data:
|
||||||||||||
Days in claims payable, fee-for-service
|
38 | 44 | 40 | |||||||||
Number of members at end of period
|
1,820,000 | 1,825,000 | 1,797,000 | |||||||||
Number of claims in inventory at end of period
|
135,400 | 260,800 | 122,700 | |||||||||
Billed charges of claims in inventory at end of period
|
$ | 236,700 | $ | 403,800 | $ | 255,200 | ||||||
Claims in inventory per member at end of period
|
0.07 | 0.14 | 0.07 | |||||||||
Billed charges of claims in inventory per member
at end of period
|
$ | 130.05 | $ | 221.26 | $ | 142.01 | ||||||
Number of claims received during the period
|
5,271,000 | 4,855,600 | 20,842,400 | |||||||||
Billed charges of claims received during the period
|
$ | 5,170,700 | $ | 4,337,000 | $ | 19,429,300 |