Western Health Advantage grows as Sacramento-area HMO

10/14/2012 12:00 AM

10/12/2012 8:42 PM

Quick, name a Sacramento-based enterprise that actually grew during the recession and amassed revenue of nearly $450 million last year.

Chances are, Western Health Advantage, the not-for-profit health plan provider, was not at the top of your list.

But 16-year-old WHA is currently on a fast track, poised to spread beyond its Sacramento-Solano area core to form a provider and hospital network in Marin, Napa and Sonoma counties.

WHA is eagerly awaiting California Department of Managed Health Care approval of its application to serve the North Bay counties, clearing it to begin offering coverage to employers, families and individuals on Jan. 1.

Garry Maisel, president and CEO, said WHA operates on a basic formula: "We believe in local. We believe in outstanding customer service. And although we have a number of larger employers, we also serve smaller employers, such as contractors with 50 or fewer employees."

Over the past two years, WHA has won significant recognition.

The 2012 Health Care Quality Report Card by the state Office of the Patient Advocate gave WHA state-leading marks for customer service and paying claims correctly and quickly. The state agency even gave WHA a 100 percent rating for having a live person answering member phone calls within 30 seconds or less.

And last year, the Washington, D.C.-based National Committee for Quality Assurance rated WHA a top-tier health plan among HMOs nationwide.

WHA is also benefiting from a friendlier operating environment for health plan providers.

Marta Green. a spokeswoman for the Department of Managed Health Care, said, "We've had a surge in applications." The recent rush to provide coverage includes six applications for new licenses, eight applications to expand into lines of business, and eight new product designs.

Among those seeking approval is Sacramento's Sutter Health, which recently applied for an HMO license to sell its own insurance. Sutter aims to offer HMO products for small- and midsize employers in the greater Sacramento and Central Valley regions in early 2014.

There are myriad reasons for the bump up in applications. They include provisions in the Affordable Care Act that open up new markets for health insurers, and an aging mass of baby boomers shopping for affordable care.

Chet Hewitt, president and CEO of Sierra Health Foundation in Sacramento, recently projected that 227,500 new enrollees will enter the four-county Sacramento region health care market when the state launches its health exchange in January 2014. That includes people who cannot afford insurance and those whose employers do not offer insurance.

It's a big shift from a little over 10 years ago, when Sacramento was considered a potential graveyard for HMOs.

In May 1999, Sacramento-based HMO Omni Healthcare, owned by Sutter Health and St. Joseph's Regional Health System of Stockton, announced that it was pulling the plug on operations, designating Blue Cross of California as its successor. At the time, Omni covered about 124,000 Northern Californians, but it reported a $2 million loss in 1998.

At that time, WHA was a fledgling operation, and Maisel recalled that "people thought we were crazy" to get into the game. However, after more than five years in business – and losses totaling more than $7 million – WHA started seeing success.

Brent Barnhart, director of the state's managed health care department, remembers that HMOs "were seen as the villains in popular culture in the late 1990s. That was some place where you didn't want to go."

Barnhart said the tide turned with "extensive legislation for regulating abuses" and coverage of services once excluded from some health plans, particularly maternity care.

"We're moving back into an era where there will be no differences at all in the marketplace," Barnhart said. By 2014, he said, "Every plan will have to provide the same level of service."

WHA has about 92,000 members. By July 1, Maisel hopes to zip past the 100,000 threshold.

The not-for-profit's presence in the Sacramento region is heavy on school districts and auto retailers. Nine school districts, including San Juan Unified, and 17 auto dealer groups offer WHA coverage to their employees.

The dealer groups include the Niello Co., the Von Housen Automotive Group of Mercedes-Benz dealers and the Sullivan Automotive Group, which oversees John L. Sullivan Chevrolet and Roseville Toyota in the Roseville Automall.

"We've had a good experience with (WHA)," said Martin Camsey, vice president and chief financial officer with the Niello Co. "They've been cost-competitive. We enjoy the relationship, and they're helpful.

"Mostly, we're happy with them as a low-priced alternative with a good base of physicians and hospitals."

Beyond the pending North Bay expansion, Maisel said WHA is looking to offer its services in "two or three additional counties in Northern California" by 2014 or 2015.

For all its growth plans, Maisel said WHA is deeply committed to the Sacramento community.

WHA has been a longtime supporter of Sacramento-area theater and the arts. It was an early contributor to the Mondavi Center at the University of California, Davis, and Maisel has served as co-chairman of the For Arts' Sake initiative in Sacramento.

Maisel also chairs the board of Women Escaping a Violent Environment in Sacramento.


What: Not-for-profit health plan provider. Founded: 1996, a collaboration of the UC Davis Health System, Dignity Health and NorthBay Healthcare System.

Headquarters: 2349 Gateway Oaks Drive, Suite 100, Sacramento.

Employees: 107

Members: 92,000

Reach: Members can choose from more than 2,800 primary and specialty care providers and 15 hospitals in Northern California.

Most recent annual revenue: $440 million

Sacramento-Solano presence: Hill Physicians Medical Group, NorthBay Healthcare, Mercy/Dignity Health, UC Davis Health System, Woodland Healthcare/Dignity Health.

Latest move: A partnership with Meritage Medical Network to form a provider and hospital network in Marin, Napa and Sonoma counties. Pending California Department of Managed Health Care approval, WHA intends to begin offering coverage to employers, families and individuals on Jan. 1.

Fast fact: Nine school districts and 17 car dealer groups in the Sacramento region offer WHA plans to their employees.

More information: www.westernhealth.com, (888) 563-2250 or (888) 499-3198.


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