The Wisconsin data set is a series of spreadsheets with multiple years of detailed data on finances and enrollment for the health plans and finances and inpatient utilization for the hospitals in the state. The health plan data come from annual NAIC statements and CMS downloads and the hospital data come from annual surveys conducted by the Wisconsin Hospital Association.
Key Findings in the New Report:
HMO enrollment grew in 9 of the past 10 years and reached almost 2 million in 2016, the highest ever. Enrollment has grown in all lines of business: individual and group, Medicaid and Medicare. Health plans have combined and two new health plans have formed, one co-sponsored by Anthem Blue Cross Blue Shield and Aurora Health.
Medicare plans are gaining popularity here and have been strongly profitable for companies like UnitedHealthcare, Humana and Security Health Plan. HMOs had net income of $214 million in 2016, or about 1.7% of underwriting revenues. However, four insurers, including Molina Healthcare, Common Ground and Security Health (owned by Marshfield Clinic) posted large losses on their individual plans. Anthem Blue Cross Blue Shield of Wisconsin (not including its Compcare HMO) had net income of $81.2 million, or 10.7% of underwriting revenues.
Hospitals in the Milwaukee region reported net income of $796.4 million in 2016, or 10.5% in net patient revenue. However, that is down from an average margin of 12.3% in 2014. Aurora Health was the most profitable, with net income of $404.4 million, or 16.2% of net patient revenues. Hospitals in and around Madison had net income of $211.9 million, or 7.3% of net patient revenues, down from margins of 8.3% in 2015.
Systems continue to make large capital investments in new and rebuilt hospitals, specialty centers and convenient care sites, even though they are competing for a shrinking pie of inpatient care. The combined Ascension systems, including Ministry, Columbia-St. Mary's and Wheaton Franciscan, had hospital patient care revenues of $3.306 billion in 2016, the highest of any system. Aurora is the second largest system based on hospital revenues.
2. Market Structure
- Health Plans
- Provider Systems
3. Trend Review
- Health Plan Enrollment
- Medicaid Managed Care
- Medicare Plans
- Health Plan Net Income
- Financial Results by Line of Business
- Provider Payments
- Administrative Expenses
- Health Plan Capital
4. A Look Ahead