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Providence dethrones Moda in new signups


Oregonians who buy their own health insurance signed up in droves for Providence Health Plan for 2016, dethroning previous market leader Moda Health, new enrollment numbers reveal.

The numbers suggest that a third or more of Oregonians who buy their own insurance may have changed insurers this year, showing the new reality under the Affordable Care Act — every year is a different world of rates, benefits, and provider networks.

It could have been worse. Moda’s well-publicized struggles sparked state officials to take partial control of the company late last month. On Monday, the state announced a plan to inject roughly $180 million into the company, allowing 63,000 members in the individual market to stay with Moda Health.

As a result, Moda will keep the No. 2 spot in enrollment, according to preliminary numbers released under Oregon Public Records Law.

The enrollment data is preliminary, officials caution. And not all of the 244,000 people who enrolled in the individual market this year will pay their first month’s premium, which is required to fully enroll.

And yet the enrollment numbers are significant. They provide the first clear picture of how consumers in Oregon reacted to a dramatic rejiggering of health premiums, including a 25 percent average hike by former market leader Moda. Open enrollment for 2016 coverage closed Jan. 31.

“Open enrollment has been successful for Providence Health Plan, with membership growth in all lines of business, including our individual and family products and plans,” says spokesman Gary Walker. “We believe our commitment to service, customer value and our integrated care model are the key reasons so many Oregonians have selected our plans.”

Portland health insurance agent Rick Skayhan says the Moda rate hike, combined with a reduction in its network, helped drive the changes, especially Providence’s gains.

“Providence ended up with a double win in that process,” he says. “They had good designs and good rates.”

Overall, Providence’s enrollment more than tripled, jumping from about 30,000 to more than 100,000, according to the state’s numbers. That roughly 40 percent market share is what Moda had last year.

The Catholic health care network, which is affiliated with the Sisters of Providence, is based in Renton, Wash.

Moda had leaped to a market lead in 2014 by offering highly competitive rates, so low that some accused the firm of underpricing its wares.

It raised its rates in 2015, but maintained its dominance among Oregonians who buy their own policies but are not in Medicare.

This year, disruptions to Moda’s network, and other warning signs, helped drive consumers to leave the company in droves. Providence, whose providers had been part of Moda’s network, was poised to capitalize, since many of those who switched could keep their same physician.

Other shifts in the 2016 market were driven by the pullout of two insurers, Health Republic and Time Insurance, who’d served more than 7,000 Oregonians last year. Health Republic — which also had used the Providence provider network — is phasing out of business, citing federal and state actions that made it hard to survive.

Taking third place in the enrollment report is Kaiser Foundation Health Plan, which notched 10 percent of the market with 23,775 enrollees.

LifeWise took fourth, with 8 percent.

Once-dominant Regence Blue Cross Blue Shield, combined with its sister company Bridgespan, continued its decline in the individual market, taking 6 percent of the market with 15,000 total enrollees.

Oregon’s Health Co-op followed, at 5 percent), with PacificSource (2 percent) and Atrio (1 percent) not far behind.

One surprising outcome was that Zoom+, a startup health plan based on the burgeoning ZoomCare clinic chain, drew only 1,654 enrollees. The chain had proposed the lowest rates in the market, only to have the state approve a higher rate.

“The competitive advantage we thought they’d get, they didn’t get,” Skayhan says.

By Nick Budnick
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