Humana 2013 Annual Report Download - page 24

Membership
The following table summarizes our total medical membership at December 31, 2013, by market and
product:
Retail Segment Employer Group Segment
(in thousands)
Individual
Medicare
Advantage
Individual
Medicare
stand-
alone PDP
Individual
Commercial
State-
based
contracts
Fully-
insured
commercial
Group
Group
Medicare
Advantage
and stand-
alone PDP ASO
Other
Businesses Total
Percent
of Total
Florida .......... 415.2 278.6 82.1 70.0 152.7 22.8 38.7 0 1,060.1 8.8%
Texas ........... 153.9 224.3 107.7 0 293.6 58.3 111.9 0 949.7 7.9%
Kentucky ........ 55.8 120.1 25.0 15.5 104.5 76.3 488.5 0 885.7 7.4%
Ohio ............ 61.4 105.7 7.7 0 53.2 148.4 141.1 0 517.5 4.3%
Illinois .......... 72.9 106.8 39.0 0 134.0 9.0 93.4 0 455.1 3.8%
California ........ 24.2 348.6 5.1 0 0.1 0.1 0.1 0 378.2 3.2%
Georgia ......... 72.2 63.4 72.2 0 120.3 7.6 41.1 0 376.8 3.1%
Wisconsin ....... 49.1 62.4 13.6 0 88.7 13.1 116.0 0 342.9 2.9%
Missouri/Kansas . . 81.8 140.4 15.2 0 44.8 5.3 7.4 0 294.9 2.5%
Tennessee ........ 108.3 74.3 22.4 0 44.6 2.1 38.8 0 290.5 2.4%
Louisiana ........ 114.9 38.7 20.8 0 50.4 6.7 29.2 0 260.7 2.2%
Virginia ......... 107.4 86.3 4.3 0 0 3.5 0 0 201.5 1.7%
North Carolina .... 71.8 117.9 5.8 0 0.1 0.5 0 0 196.1 1.6%
Indiana .......... 54.2 78.4 8.7 0 21.7 3.7 18.0 0 184.7 1.5%
Michigan ........ 48.6 96.8 12.0 0 10.3 13.1 2.6 0 183.4 1.5%
Colorado ........ 27.6 61.4 37.0 0 18.4 6.2 0.4 0 151.0 1.3%
Arizona ......... 45.2 53.1 19.3 0 24.8 1.5 2.1 0 146.0 1.2%
Military services . . 0 0 0 0 0 0 0 3,101.8 3,101.8 25.9%
Others ........... 504.2 1,214.5 102.2 0 74.8 55.1 33.5 23.4 2,007.7 16.8%
Totals ....... 2,068.7 3,271.7 600.1 85.5 1,237.0 433.3 1,162.8 3,125.2 11,984.3 100.0%
Provider Arrangements
We provide our members with access to health care services through our networks of health care providers
whom we employ or with whom we have contracted, including hospitals and other independent facilities such as
outpatient surgery centers, primary care providers, specialist physicians, dentists, and providers of ancillary
health care services and facilities. These ancillary services and facilities include laboratories, ambulance services,
medical equipment services, home health agencies, mental health providers, rehabilitation facilities, nursing
homes, optical services, and pharmacies. Our membership base and the ability to influence where our members
seek care generally enable us to obtain contractual discounts with providers.
We use a variety of techniques to provide access to effective and efficient use of health care services for our
members. These techniques include the coordination of care for our members, product and benefit designs,
hospital inpatient management systems, the use of sophisticated analytics, and enrolling members into various
care management programs. The focal point for health care services in many of our HMO networks is the
primary care provider who, under contract with us, provides services to our members, and may control utilization
of appropriate services by directing or approving hospitalization and referrals to specialists and other providers.
Some physicians may have arrangements under which they can earn bonuses when certain target goals relating to
the provision of quality patient care are met. We have available care management programs related to complex
chronic conditions such as congestive heart failure and coronary artery disease. We also have programs for
prenatal and premature infant care, asthma related illness, end stage renal disease, diabetes, cancer, and certain
other conditions.
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