There were a lot of similarities in the first-quarter 2009 earnings results for UnitedHealth Group and WellPoint, the first of the major managed care organizations to release results for the quarter.
Both reported a decline in net income. Both reported an increase in earnings per share (tied to a drop in diluted shares outstanding). Both easily beat Wall Street expectations. Both saw a decline in fully funded membership.
Generally speaking, I think you’d have to conclude the results were good (although the initial Wall Street reaction was mixed)—and that’s good news for managed care companies in general as they attempt to price their way out of last year’s underwriting downcycle.
One broader, nagging concern is the continued drop in fully funded membership.
WellPoint’s fully funded lives fell 3.7% in the quarter, compared to a year earlier year-end 2008, a faster rate of decline than the company had expected. United’s commercial risk business fell 4.3%, slightly better than expected.
No doubt, the struggling economy was a big factor, but as an industry-wide trend, fully funded enrollment has been under pressure for some time.
Meanwhile, there were lots of questions from Wall Street analysts on WellPoint’s earnings conference call about the impact of consumer-directed business on the company’s medical cost ratio.
WellPoint’s MCR improved 350 basis points to 81.6% in the quarter, but the company expects its MCR to deteriorate through the year as CDHP members hit their deductibles and benefits kick in. Still, the big improvement raises the possibility that profits will come in better-than-expected for the year.
Joshua Raskin of Barclays Capital basically summed up the Street’s confusion, noting even though WellPoint’s CDHP membership rose 14% to 2 million, “I can’t understand how that’s a 350 basis point impact” on the MCR.
The question relates to the seasonality of CDHPs. You’ll recall a couple of years back when United failed to adequately forecast the fact that high-deductible health plan costs tend to soar late in the year when members rush to get treatment before the deductible resets for the next year.
WellPoint officials on the call indicated that they were leaving a lot of room for error through 2009, not just in projecting CDHP costs, but also in forecasting the impact of the economy on business overall.
All of which suggests that the health insurance industry is dealing with an array of short-term and long-term issues: among them, learning how to forecast CDHP business, assessing the impact of a down economy, navigating what appears to be the tail-end of an underwriting downcycle, and stressing out over Obama’s healthcare reform goals.
Here’s another: Couple the growth in low-premium CDHPs with an overall decline in risk business, and you’ve got the potential for some long-term pain in health plan profitability. No wonder investors are wary.