NEWS RELEASE
Embargoed for edition on Wednesday, March 2, 2022
CONTACT: Allan Baumgarten, 952/212-8589
Florida Health Market Review 2021 finds:
COVID-19 pandemic drives higher enrollment and profits for health insurers.
Federal funds help Florida hospital systems to maintain profitability.
Even as the COVID-19 pandemic imposed a terrible toll of illness and death in Florida, hospital systems and health insurance companies maintained their strong profitability. Enrollment in managed care plans increased, and hospital systems continued their strategies of growth through acquisitions and new construction.
These and other findings are presented in Florida Health Market Review 2021, Allan Baumgarten’s 16th report analyzing the financial performance and competitive strategies of Florida’s health care payer and provider organizations. Baumgarten is a Minneapolis-based analyst who publishes reports examining health market trends and competition in Florida and five other states: Colorado, Michigan, Minnesota, Ohio and Texas. He also conducts project research and has completed reports sponsored by the Robert Wood Johnson Foundation analyzing new provider-sponsored health plans and how states contract with Medicaid managed care organizations and oversee their performance. PDFs or excerpts from his reports can be downloaded at www.AllanBaumgarten.com
Key findings in the new report:
- Florida hospital systems continued their strong profitability in 2020, with hospitals in South Florida reporting net income of $1.59 billion or 9.6% of net patient revenues.
That was less than their record profits of $2.012 billion in 2019 (11.7% of revenues) based on an analysis of data from the state’s annual survey of hospitals. Florida hospitals generally maintained strong profitability even in the face of some higher expenses and reduced revenues from surgeries that were suspended during several months of 2020. Many hospitals received millions in provider relief aid from the federal government, which made up for reduced operating income. In the Tampa-St. Petersburg region, hospitals improved their average margins from 8.8% in 2018 to 10% in 2020.
HCA, the largest hospital system in the state with more than 40 hospitals, had net income of $2.07 billion, or 23% of patient revenues. AdventHealth, the second largest system here, had net income of $693.8 million or 9.8% of patient revenues. In South Florida, the Baptist Health system, which has acquired three hospitals in Palm Beach County, saw its net income grow from $142.8 million in 2018 to $465 million in 2019, but then drop to $246.3 million in 2020.
- Hospital systems are pursuing growth strategies including acquisitions, construction of new hospitals, outpatient centers and free-standing emergency departments, seeking to expand their geographic reach, patient count and top-line revenues.
HCA has recently acquired or built hospitals and announced plans to build three new hospitals in the state. It also acquired the largest operator of urgent care centers in the state and plans to add new urgent care clinics. Now that the state has repealed most of its Certificate of Need rules, other systems, including academic medical centers and hospital districts, are breaking ground on new projects. Even so, systems like Tenet Health and Community Health Systems are downsizing their hospital presence in the state, selling several of their hospitals.
- Even with the new hospital construction, inpatient utilization declined in 2020 in South Florida and increased only slightly in other parts of the state.
Inpatient hospital days at South Florida hospitals declined by 2.3% between 2018 and 2020 and the average daily occupancy rate dropped from 58.5% to 54.9%. Hospitals in the Orlando region increased their capacity by 0.5% but inpatient days grew by only 0.1%.
- Florida HMOs increased their profits by 72.9% in 2019 and by 17.1% in 2020.
They reported net income of more than $2 billion in 2020, or 3.7% of premium revenue. The Humana HMOs had net income of $604.2 million, while the Blue Cross Blue Shield HMOs had net income of $447 million, or 6.3%, Blue Cross Blue Shield (Florida Blue) had net income of $470.7 million. In many cases, their medical expenses declined as hospitals suspended non-emergency surgeries or as patient deferred care.
- Enrollment in HMOs in the state increased by almost 9% in 2020, with increased members in Medicaid managed care. Medicare Advantage and individual plans.
Enrollment in Medicaid plans grew by 570,000 in 2020, or 19.6%. It continued to grow in the first three quarters of 2021, adding 467,000 more members. Medicaid HMOs had underwriting income (before investment revenues and taxes) of almost $600 million in 2020. Medicaid is a lucrative line of business for these companies and competition for the contracts will be fierce when the state launches a new procurement in the next few years. It has also become very concentrated in Florida, with the merger of WellCare and Centene (doing business as Sunshine State) creating a company with 47% of total Medicaid managed care enrollment
- More than half of Medicare beneficiaries in the state are now enrolled in a Medicare Advantage plan.
About 65% of them are in an HMO plan, and their enrollment and profits have grown steadily. Medicare HMOs in Florida had underwriting income of $1.164 billion in 2020, or 4.4% of premiums. Humana has the largest Medicare HMO membership, and its two HMOs had underwriting income in 2020 of $668.6 million or 6.2% of underwriting revenues. UnitedHealthcare’s HMOs are the next largest, and Anthem has acquired four Medicare HMOs in the state since 2017 and is the third largest.
Excerpts from the report and information about ordering the report and data set can be found at www.AllanBaumgarten.com. For additional information, contact him at baumg010@umn.edu or 952/212-8589.
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CONTACT: Allan Baumgarten, Cellular: 952/212-8589
Florida Health Market Review 2019 finds: Florida hospitals continue expansion strategies and enjoy stronger profits; Consolidated HMOs report improved profitability but fewer members.
Continued consolidation by health insurers and hospitals systems combined with coverage expansion has improved profits for both. Profits for Florida HMOs increased by 12% in 2018, and South Florida hospitals reported average profit margins of 8%, their highest in recent years.
These and other findings are presented in Florida Health Market Review 2019, Allan Baumgarten’s 15th report analyzing the performance and competitive strategies of Florida’s health care payer and provider organizations. Baumgarten, an independent analyst based in Minnesota, analyzes health market trends and competition in Florida and five other states: Colorado, Michigan, Minnesota, Ohio and Texas. He is also the author of reports published by the Robert Wood Johnson Foundation analyzing new provider-sponsored health plans and provider system strategies in New Jersey. PDFs or excerpts from his market reports can be downloaded at www.AllanBaumgarten.com
The new Florida analysis shows: ª Hospital systems have grown through new construction and acquisitions. The largest hospital systems in the state-HCA and Advent Health-reported very strong profit margins in 2018: 15.3% and 10.8%, respectively. Both acquired hospitals from Community Health Systems, once the seventh largest system in the state. Both systems have a presence in much of the state, giving them significant market power in dealing with employers and health plans. New hospitals, health centers and free-standing emergency departments have been constructed in many parts of the state, and that investment is likely to increase with the repeal of most of the state’s Certificate of Need program.
• South Florida hospitals recorded combined profits of $1.279 billion in 2018 and have posted combined profits above $1 billion for four of the past five years. Based on financial and utilization data from the state’s annual survey of hospitals, the report finds that hospitals in South Florida posted average margins of 8% of net patient service revenues in 2018, up from 5.9% in 2017 and 7.5% in 2016. They had operating income of $713.3 million and other revenues of $709.1 million, including investments, philanthropy and government grants. HCA was the most profitable, with net income of $363.6 million, or 14.4% of net patient revenues. Baptist Health, the largest system in the region, had net income of $142.8 million, while the Memorial system in Broward County had net income of $158.6 million.
• Hospitals in the Orlando area had average margins of 12.9% in 2018, up from 11.6% in 2016. Orlando Health, the second largest system there, posted net income of $531.4 million and a margin of 20%, while AdventHealth, the largest system, had net income of $539.3 million and a 13.4% margin. Even so, inpatient days and occupancy dropped in the region. In the Tampa-St. Petersburg area, hospitals had net income of $934.1 million and average margins of 8.8%. HCA and BayCare reported the best financial results, while Bayfront Health/Community Health Systems reported a loss of $116.8 million. Hospitals in the Jacksonville area had higher average margins than the other three regions: 13.1% of patient services revenues, with the Baptist hospitals and Mayo Clinicc reporting the highest net income.
• The health insurance market has grown significantly more concentrated in the last three years, as companies like Anthem and Blue Cross Blue Shield have acquired a number of HMOs. In 2018, the four largest HMO companies- the five Blue Cross Blue Shield HMOs, Humana, UnitedHealthcare’s HMOs and WellCare-had 64.2% of the market, compared to 51.5% two years earlier.
• As a result of their market power and favorable claims experience, HMOs enjoyed strong profits in 2018, particularly on their individual and Medicare Advantage plans. Florida HMOs had net income of just under $1 billion in 2018, or 2.2% of premium revenues. That compares to combined net income of $891.1 million in 2017. Molina, Humana and WellCare had the highest margins. In addition, Blue Cross Blue Shield had net income of $694.6 million on its PPO plans.
• Medicare Advantage plans had underwriting income of $724.9 million down from $800 million in 2016, but still very strong. Underwriting income for commercial (individual and group) plans increased from $172 million in 2016 to $725.3 million in 2018. Blue Cross Blue Shield has been very successful in the individual market and had $936.8 million in underwriting profit on its group and individual plans. New competitors – Oscar and Bright Health - have entered the individual market in much of the state – and premium rates have dropped for most plans.
• After years of steady growth, enrollment in Florida HMOs fell by 2.2% in 2018. Enrollment in Medicaid and commercial plans fell. UnitedHealthcare’s HMOs, WellCare and Blue Cross Blue Shield’s PPOs added the most new enrollees. ###
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Exhibit 1Click to View
Agency for Health Care Administration
Baptist Health Systems of South Florida
Blue Cross Blue Shield of Florida
Florida Association of Health Plans
Florida Department of Children and Families
Florida Office of Insurance Regulation
Florida Hospital Association (FHA)
Florida Healthy Kids Corporation
Florida Legislature, Office of Economic and Demographic Research
Morton Plant Mease Health Center
Introduction........................................................................................................ 3
Market Structure................................................................................................ 4
Health Plans ........................................................................................................................... 4
Provider Systems .................................................................................................................... 9
Trend Analysis....................................................................................................................... 14
Enrollment ............................................................................................................................... 14
Medicare HMOs ...................................................................................................................... 16
Medicaid Managed Care ..................................................................................................... 18
Enrollment by Region .......................................................................................................... 20
HMO Profitability ................................................................................................................ 21
Financial Metrics ................................................................................................................. 22
Provider Payments ............................................................................................................... 26
Administrative Expense ....................................................................................................... 28
HMO Net Worth and Capital ................................................................................................ 28
Hospital Systems and Regional Submarkets ................................................. 29
South Florida ........................................................................................................................ 30
ampa-St. Petersburg ........................................................................................................... 36
Jacksonville-Gainesville ........................................................................................................ 39
Orlando ................................................................................................................................ 41
A Look Ahead .............................................................................................. 44
Florida Health Market Review 2017 was released December 13: "HMOs return to profitability and reach record enrollment numbers; Florida hospitals continue expansion strategies and enjoy strong profits"
- Sammy Mack reported on WLRN Public Radio: "From Patients to Hospitals, Affordable Care Act Shapes Florida Health Care Market, Analyst Says." Click here to listen
- Charles Elmore quotes the new report in the Palm Beach Post: "Hurricane Irma, political storms roil finish of sign-up season." Click here to read
- Ron Hurtibise reported in the Sun Sentinel: "Profits for Broward's two public hospital systems going opposite ways." Click here to read
- Margie Manning wrote in the Tampa Bay Business Journal: "Here are the most profitable systems in Tampa Bay." Click here to read
Florida Health Market Review 2015 was released November 18: "Hospital systems expand and consolidate, report improved profits; HMO Medicaid and individual enrollment surges, but profits drop"
- Sammy Mack reported in Health News Florida: "Negotiating Power Shifts as Hospitals Consolidate" Click here to listen and read
- Charles Elmore wrote in the Palm Beach Post: "Florida HMO Enrollment Jumps 44% to biggest ever, report says" Click here to read
- Nina Lincoff wrote in the South Florida Business Journal: "Hospital network and health plan consolidation expected to continue in Florida" Click here to read
- Margie Manning wrote in the Tampa Bay Business Journal: "Humana leads, WellCare lags among Florida HMOs" Click here to read. She also wrote: "Here's a Peek at the Hospital of the Future." Click here to read.
- Ron Hurtibise wrote in the SunSentinel: "Hospital profits jump nearly 40%" Click here to read
- Naseem Miller reported in the Orlando Sentinel: "Report reveals most profitable hospital in central Florida." Click here to read
- Daniel Chang wrote in the Miami Heralnd: "How Baptist Health benefits from tax exemption." Click here to read
Florida Health Market Review 2013 was released September 13: "Consolidated hospital systems see profits despite declining utilization; HMO Medicare and commercial plans are strongly profitable"
- Abraham Aboraya wrote in the Orlando Business Journal: "Florida's most, and least profitable health plans"
- Brian Bandell wrote in the South Florida Business Journal: "Local hospital profits surge $51 million" and "Commercial HMOs report healthy profit margins"
- Allan Baumgarten presented at the annual conference of the South Florida Hospital and Healthcare Association on June 10, 2011. Click here to download his presentation on: "Managed Care: Can It Be Managed?"