Despite many payers suffering huge losses on the Affordable Care Act exchanges, California-based Molina Healthcare has fared well financially, according to The Hill.
Here are six things to know:
1. Molina CEO Mario Molina, MD, said the payer has reaped success because it has had to continually rein in costs when selling Medicaid plans. Dr. Molina told The Hill, "In the Medicaid environment, we don't have ability to raise prices or raise premiums. We have to learn to live within a budget, and that's very different than on the commercial side."
2. By the end to this year, Molina projects revenue hitting $16 billion, which exceeds the company's profit expectations.
3. Based on its successes, Molina plans to expand into more markets, including Florida and California. Leading payers UnitedHealth and Aetna recently left markets in those two states.
4. Dr. Molina said the payer also attributes its success to offering inexpensive plans to lower income Americans. Molina has a narrow provider network, with Dr. Molina saying, "We don't offer everybody, but we offer a lot. I think this issue about narrow networks versus broad networks has really been overblown."
5. He also said every payer under the ACA should offer the same types of services as many patients would prefer to obtain care at local hospitals.
6. Molina offers its ACA consumers health maintenance organization plans, as opposed to preferred provider organizations, which companies like UnitedHealth offer. This year, Blue Cross Blue Shield took some of its PPO plans off the Texas and Minnesota markets, but still offered its HMO plans.
More articles on coding & billing:
Goldman Sachs analyst predicts Anthem to leave exchanges in 2018: 4 takeaways
After Anthem responds to antitrust case, Cigna follows suit: 4 things you need to know
CPA: How health insurers became cable companies — 5 things to know