Sky is Not Falling in Managed Care

Les Masterson, for HealthLeaders Media, September 24, 2008

I'm not someone who is interested in the stock market. I don't know the difference between bear and bull markets and the closest I have come to watching the stock exchange is that scene from "Trading Places."

Like many Americans, I have a 401(k), but my company handles that and I'm in it for the long haul so market fluctuations don't bother me. Then, I read over the past week about potential problems with money markets.

I'm now paying attention.

This singular view on the world of finances is understandable. We often wait until something affects us dramatically and immediately before paying attention.

Those in the health insurance field probably experienced similar feelings over the past week. They watched the financial trouble and asked first "How does it affect my family?" and second "How does this affect my job?"

I was curious about how the financial crisis will impact health insurance companies so I spoke to managed care financial expert Joe Paduda about the state of the industry. Paduda is principal of Health Strategy Associates, a healthcare consulting company in Madison, CT, and writes the Managed Care Matters blog.

Health insurance employees will be glad to hear that Paduda doesn't think the stock market problems will impact managed care plans. Health plan stocks were already rocked earlier this year so any decline should be less than the overall market, he says.

Despite this article about Aetna, health plans won't be hurt much directly by the financial market's collapse either, because they usually invest conservatively. In fact, Aetna's exposure to the recent problems is a mere 2% of its portfolio, says Paduda.

Unlike insurers in other industries who pay claims for workers compensation, property, and pollution, health plans can usually predict their claims for the following year, so they tend to invest conservatively.

Think of it this way: How does a company that provides homeowners' insurance know if Florida is going to get hit by three major hurricanes or none in a given year? Health insurers, on the other hand, can estimate how much they will pay in claims. Having that predicable information, health insurers can invest accordingly.

Managed care companies may avoid much of the financial calamity, but the market collapse will impact health plans in another way. Last Thursday, Fitch Ratings proposed new ratings criteria to analyze financial leverage of health insurers. Rather than using debt-to-capital ratio, Fitch will look at specifics like cash flow and earnings as a way to measure the financial viability of health insurance companies. Fitch will publish any changes to the methodology after receiving industry feedback. The company is seeking comments about the proposal until Oct. 15.

If the plan goes into effect, Paduda says Fitch would take a "more granular look at the profits driven by the health insurers, and they want to be a lot more specific and a lot more detailed about understanding what the cash flow looks like because that cash flow has to pay future claims." He expects other rating companies will follow suit.

Paduda says Fitch's move is the first major shift in health insurer ratings in more than 25 years. He doesn't think the changes will vastly affect the individual health insurer ratings, but some companies may see a slight uptick or downtick. The greater issue for health plans will be that they now have to focus more on cash flow and worry less about debt-to-capital ratio.

Paduda says Fitch's move is a good call, and the new system will determine if the insurers are financially viable. "What this whole credit debacle has shown is that we were not analyzing [and] accessing the right thing."

Market fluctuations are having a disastrous effect on other industries, but Paduda says health insurers will be impacted more by healthcare reform and Medicare physician reimbursement.

Les Masterson is senior editor of Health Plan Insider. He can be reached at

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