OUTLOOK ‘STABLE’ FOR HEALTH INSURERS IN 2019 DESPITE ACA UNCERTAINTY

https://www.healthleadersmedia.com/finance/outlook-stable-health-insurers-2019-despite-aca-uncertainty

A robust job market bolstering employer-sponsored plans, Baby Boomers transitioning to Medicare Advantage, and ACA exchanges attracting new payers are good signs for health plans in the coming year.


KEY TAKEAWAYS

Consolidations among larger payers makes it harder for smaller players to enter the market or sustain a presence.

Payment reforms around the ACA will continue to drive more cross-sector collaboration among payers and providers.

Despite the uncertainty over the future of the Affordable Care Act, the U.S. health insurance sector remains stable heading into 2019, according to a new analysis by S&P Global Ratings.

“A combination of still-favorable business conditions, financial factors, and diminished near-term legislative uncertainty balances our concerns relating to merger and acquisition activity, elevated policy risk, and re-emergent legal overhang,” said S&P analyst Joseph Marinucci.

Strong job growth is bolstering commercial markets, aging Baby Boomers are driving Medicare Advantage growth, states are shifting their high acuity populations into managed Medicaid, and the ACA exchanges are stabilizing and attracting new competitors, S&P said.

“We assess capital and liquidity as strong or better for most of our rated U.S. health insurers, which supports balance-sheet strength,” Marinucci said. “U.S. health insurers’ operating performance reflects sustained earnings strength and improved earnings quality.”

However, Marinucci said that profitability could moderate somewhat this year.

M&As remain a key rating factor, especially with larger transaction sizes, raising concerns about financial leverage, integration, and cultural compatibility. Consolidations, joint ventures, and partnering among larger insurers are defragmenting the sector, allowing the big insurers to build scale, “and create more touch points as the trend toward consumerism gains traction.”

This is making it harder for newer and smaller players to enter the market or sustain their presence,” S&P said. “As a result, we continue to see larger health insurers taking a bigger share of the marketplace, and smaller players being displaced or struggling to achieve profitable growth as the competitive gap widens.”

“Although the mid-term elections removed a good deal of legislative uncertainty for the industry, policy risk remains elevated given the administration’s preference for ACA alternatives,” S&P said.

In addition, S&P says that payment and delivery reforms mandated in the ACA around value-based care will continue to drive greater cross-sector collaboration among payers and providers.

“A COMBINATION OF STILL-FAVORABLE BUSINESS CONDITIONS, FINANCIAL FACTORS, AND DIMINISHED NEAR-TERM LEGISLATIVE UNCERTAINTY BALANCES OUR CONCERNS RELATING TO MERGER AND ACQUISITION ACTIVITY, ELEVATED POLICY RISK, AND RE-EMERGENT LEGAL OVERHANG.”

 

 

 

NOT-FOR-PROFIT OPERATING MARGINS CONTINUE TO DECLINE

https://www.healthleadersmedia.com/finance/not-profit-operating-margins-continue-decline?utm_source=silverpop&utm_medium=email&utm_campaign=ENL_180801_LDR_BREAKING_DeKalb_Emory%20(1)&spMailingID=14040768&spUserID=MTY3ODg4NTg1MzQ4S0&spJobID=1460932625&spReportId=MTQ2MDkzMjYyNQS2

Operating margins for systems and hospitals continued to decline due to increasing expense pressures as well as slowing net patient revenue growth across all rating levels.


KEY TAKEAWAYS

Strong balance sheets and capable leadership continue to lead the way for stable success.

M&A activity has bolstered the financial standing and credit ratings of not-for-profit health systems.

Not-for-profit systems are outnumbering stand-alone hospitals through increased M&A activity.

Stand-alone hospitals experienced their second consecutive year of negative outlooks.

Not-for-profit health systems and stand-alone hospitals have maintained generally favorable bond ratings due in large part to strong balance sheets, despite the continual decline in operating margins and cash flows.

S&P Global Ratings released research this week on the financial status of not-for-profit health systems and stand-alone hospitals in 2017.

The sector remained consistent in several year-to-year, such as improving days’ cash-on-hand levels and marginal reduction in debt levels, though the study found that the underlying pressures on not-for-profits are beginning to take their toll. The operating margin for the sector declined from 2.4% in 2016 to 1.8% in 2017.

S&P also noted that not-for-profit health systems continue to outnumber stand-alone hospitals and received stronger overall ratings from the agency.

RATINGS ACTIONS FOR THE SECTOR THROUGH JUNE 22:

  • 152 total affirmations
  • 16 total upgrades, though six upgrades were driven by systems merging together.
  • 15 total downgrades

S&P said a major factor that allowed health systems and hospitals to weather financial challenges last year was the combination of strong balance sheets and leadership. 

CREDIT STRENGTHS OF NOT-FOR-PROFIT SYSTEMS:

  • Robust M&A activity has improved the financial profile for systems.
  • Despite the same challenges with maintaining an overall patient base, systems have experienced a growth in outpatient services.
  • Sizable investments in information technology have resulted in strong credit ratings.

S&P analysts said that stand-alone hospitals featured stronger medians than systems but found they are weakening. This is due to softer patient volumes, a weakening payor mix combined with increased pressure from commercial payors, and labor expenses. 

HOW STAND-ALONE HOSPITALS PERFORMED:

  • While the amount of stand-alone hospitals are shrinking, they produced stable balance sheets that were noted as a “principal strength of financial profile.
  • Debt levels fell due to declining unrestricted net assets.
  • However, negative operating margins appeared in BBB rating levels.

 

13 health systems with strong finances

https://www.beckershospitalreview.com/finance/13-health-systems-with-strong-finances-012317.html

 

Here are 13 health systems with strong operational metrics and solid financial positions, according to recent reports from Moody’s Investors Service and S&P Global Ratings.

Note: This is not an exhaustive list. Health system names were compiled from recent credit rating reports and are listed in alphabetical order.

1. Downers Grove, Ill.-based Advocate Health Care has an “Aa2” rating and stable outlook with Moody’s. The health system has a strong market position, healthy liquidity, moderate leverage and good debt metrics, according to Moody’s.

2. Morristown, N.J.-based Atlantic Health System has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. The system has stable operating performance, balance sheet growth and a favorable market position, according to Moody’s.

3. Dallas-based Baylor Scott & White Health has an “Aa3” rating and stable outlook with Moody’s. The health system has strong cash flow margins and a favorable business position as the largest nonprofit health system in Texas, according to Moody’s.

4. Milwaukee-based Children’s Hospital and Health System has an “Aa3” rating and stable outlook with Moody’s. The system has a strong balance sheet and is the dominant provider of tertiary and quaternary pediatric services in southeastern Wisconsin, according to Moody’s.

5. Indianapolis-based Indiana University Health has an “Aa2” rating and stable outlook with Moody’s. The system has healthy margins and a strong market position, according to Moody’s.

6. Rochester, Minn.-based Mayo Clinic has an “Aa2” rating and stable outlook with Moody’s. Mayo has an excellent clinical reputation and diversified revenue across multiple locations, states and types of hospitals, according to Moody’s.

7. Mercy Health in St. Louis, Mo., has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. The health system has solid debt service coverage and strong balance sheet metrics, according to Moody’s.

8. Chicago-based Northwestern Memorial HealthCare has an “Aa2” rating and stable outlook with Moody’s. The system has a prominent and growing market position in the Chicago region, a strong investment position, good margins and manageable leverage, according to Moody’s.

9. San Diego-based Sharp HealthCare has an “Aa3” rating and stable outlook with Moody’s. The system has strong balance sheet measures and a fundamentally stable and strong strategic position, according to Moody’s.

10. Stanford (Calif.) Health Care has an “Aa3” rating and stable outlook with Moody’s. The system has a strong market position as one of two major academic medical centers in the Bay Area, has a reputation for clinical excellence and research, and is in a service area with strong population growth and high wealth levels, according to Moody’s.

11. Iowa City-based University of Iowa Hospitals & Clinics has an “Aa2” rating and stable outlook with Moody’s. The health system has a broad market with growing patient volumes and geographic reach for its high-acuity services. Moody’s expects the health system’s expense control initiatives to continue to gain traction through fiscal year 2018.

12. Philadelphia-based University of Pennsylvania Health System has an “Aa3” rating and stable outlook with Moody’s. The health system has a strong market position, solid operating margins and limited debt burden, according to Moody’s.

13. Yale New Haven (Conn.) Health System has an “Aa3” rating and stable outlook with Moody’s. The system has a leading market position in Connecticut, solid liquidity, moderate capital needs and manageable leverage, according to Moody’s.