WellPoint could make $100B covering dual eligibles

WellPoint said it stands to make $100 billion by providing insurance for the dual-eligible market, which consists of certain Medicare and Medicaid enrollees who are eligible for both government programs, reported Bloomberg.

The expected large profit is a result of WellPoint's acquisition of Medicare specialist CareMore Health Group last summer. The $800 million purchase was WellPoint's attempt to compete in the senior healthcare market as a pivotal aspect of the insurer's longer-term strategic plan to integrate and coordinate care between insurers and providers, FierceHealthPayer previously reported.

As a result of the acquisition, WellPoint now owns 29 CareMore centers in California, Nevada and Arizona, and it plans to open 12 additional centers in other states this year, Bloomberg noted. CareMore specializes in intense monitoring and treatment for chronically ill older patients to improve their health while preventing their medical bills from rising.

"Because this is a group that needs highly coordinated care, you really need a model that specializes in that and that's what CareMore does for us," WellPoint CFO Wayne DeVeydt told Bloomberg. "It's kind of our missing link in being prepared for the duals, and we think we're uniquely positioned versus some of the other companies out there."

WellPoint also intends to use the CareMore model as a selling point for it to win state contracts to provide coverage for dual eligibles, which account for more than $300 billion annually. DeVeydt said WellPoint will start seeking contracts in the 14 states where it operates Blue Cross plans. And, beginning next year, WellPoint will participate in a pilot project in California to cover dual Medicare and Medicaid enrollees.

"We want to prove to our state partners and to the federal government that we can manage this population well and that we can show better value for them and save the states money," DeVeydt added.

To learn more:
- read the Bloomberg article