Managed Healthcare Executive - December 2008 - (Page 14)

{EX EC U T I V E PROFIL E} the U.S. market in areas where a high concentration of Hispanic population exists through acquisitions, joint ventures or with other Blue Cross Blue Shield plans.” TRIPLE-S MANAGEMENT CORP. YEAR FOUNDED: 1959 NYSE TICKER: GTS 52-WEEK HIGH AND LOW: $22.25 and $7.59 (November 19) NET INCOME: $58.5 million (2007) EMPLOYEES: 2,274 PROVIDER NETWORK: 16,400 locations ENROLLMENT AS OF SEPT. 2008: Commercial, Fully Insured—411,524 (41.0%) Commercial, Self Funded—176,549 (17.6%) Reform—340,710 (34.0%) Medicare—73,893 (7.4%) Total—1,002,676 MEDICAL LOSS RATIO: 87.1% (2007) 87.6% (2006) 90.3% (2005) COMPETITORS: Humana Medical Card Systems Inc. MMM Healthcare Cruz Azul (Blue Cross) Source: Triple-S Management Corp. Portfolio of products Triple-S went public one year ago this month, but Ruiz-Comas says the organization had been building up to the IPO in one way or another for years, from its founding by physicians and dentists in 1959, to adopting its Blue license in 1965, to its for-pro t beginnings in 2003, to its more recent streamlining e orts. He says the original private shareholders have endorsed the long-term vision to grow into a dominant player and then expand beyond Puerto Rico, alongside the conversion to a public company. Triple-S currently claims a 25% market share in managed care in Puerto Rico. With an atypical product mix for a Blue licensee, Triple-S might at rst appear to have a less lucrative book of business. A solid 34% of its 1 million covered lives are enrolled in Puerto Rico’s version of Medicaid, known as Reforma de Salud de Puerto Rico or just “Reform,” which is quite a bit more than other Blue plans. More than 7% of its members are enrolled in a Medicare Advantage product, and commercial business accounts for a 58% slice. For the sake of comparison, consider insurance giant WellPoint’s product mix for its 34.8 million members in 2007: just over 6% came from Medicaid and SCHIP; 3.5% came from various Medicare products; and 73% came from commercial clients. Ruiz-Comas says the company’s diversi ed portfolio spreads the risk of doing business in the contained geographic area of Puerto Rico, but he also notes the context of the products within the market. Coverage sources are signi cantly di erent compared to 14 DECEMBER 2008 the United States. “In Puerto Rico, total insured population represents approximately 90% of the total population,” he says. “Of the total population insured, approximately 50% is Reform members. We have many Reform members because as part of our strategy, we focus to provide our members the best service and help the government in its initiatives to have a successful Reform program on the island.” Triple-S projects in its third-quarter report that its total medical enrollment will grow 4% to 4.5% in 2008, with enrollment in Medicare Advantage growing 47% to 52%. “Our commitment in Puerto Rico has been to serve every market,” says Juan José Román, nance vice president and CFO. “That also allows us to have a diversi ed portfolio even within the managed care business. So not only do we have supplemental and complementary businesses in life and property and casualty business, we have diversi ed managed care into three buckets, which is Reform, Medicare and commercial.” E ective November 1, Triple-S took over an administrative-service contract for an additional region of the Reform market, which added 175,000 members to its Reform bucket. The region had been in the company’s portfolio previously, with the exception of the past two years, when

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Managed Healthcare Executive - December 2008 For Your Benefit Editorial Advisors Contents News Analysis Politics & Policy Letter of the Law Puerto Rico’s PLAN State Report Bundled Payment Technology Drug Class Overview Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - December 2008

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