Profile: Magellan Health Services Inc (MGLN.O)
11 Mar 2014
Magellan Health Services Inc., incorporated on November 13, 1995, is engaged in the specialty managed healthcare business. The Company provides services to health plans, insurance companies, employers, labor unions and various governmental agencies. The Company owns 80% interest in Magellan Complete Care of Arizona, Inc and 49% interest in Fallon Total Care, LLC. Magellan Complete Care of Arizona, Inc was formed to manage integrated behavioral and physical healthcare for recipients with SMI and behavioral healthcare for other Medicaid beneficiaries in Maricopa County. In October 2013, Magellan Health Services Inc completed its acquisition of Partners Rx.
Managed Behavioral Healthcare
The Company’s two segments are in the managed behavioral healthcare business. This line of business reflects the Company's coordination and management of the delivery of behavioral healthcare treatment services that are provided through its contracted network of third-party treatment providers, which includes psychiatrists, psychologists, other behavioral health professionals, psychiatric hospitals, general medical facilities with psychiatric beds, residential treatment centers and other treatment facilities. The treatment services provided through the Company's provider network include outpatient programs (such as counseling or therapy), intermediate care programs (such as intensive outpatient programs and partial hospitalization services), inpatient treatment and crisis intervention services. The Company generally does not directly provide or own any provider of treatment services. The Company provides its management services primarily through risk-based products, where the Company assumes all or a substantial portion of the responsibility for the cost of providing treatment services in exchange for a fixed per member per month fee, administrative services only (ASO) products, where the Company provides services, such as utilization review, claims administration and/or provider network management, but does not assume responsibility for the cost of the treatment services, and employee assistance programs (EAPs) where the Company provides short-term outpatient behavioral counseling services.
The Managed Behavioral Healthcare Commercial segment (Commercial) reflects managed behavioral healthcare services and EAP services provided under contracts with health plans and insurance companies for some or all of their commercial, Medicaid and Medicare members, as well as with employers, including corporations, governmental agencies, and labor unions. As of December 31, 2012, Commercial's covered lives were 5.4 million, 13.4 million and 12.0 million for risk-based, ASO and EAP products. The Managed Behavioral Healthcare Public Sector segment (Public Sector) generally reflects services provided to recipients under Medicaid and other state sponsored programs under contracts with state and local governmental agencies. Public Sector contracts encompass either risk-based or ASO arrangements. As of December 31, 2012, Public Sector's covered lives were 1.9 million and 1.1 million for risk-based and ASO products. The Company's managed behavioral healthcare network consists of approximately 70,000 behavioral healthcare providers, including facility locations, providing various levels of care nationwide. The Company's network providers are almost exclusively independent contractors located throughout the local areas in which the Company's customers' beneficiary populations reside.
Radiology Benefits Management
The Company’s Radiology Benefits Management segment generally reflects the management of the delivery of diagnostic imaging and other therapeutic services. The Company's radiology benefits management services are provided under contracts with health plans and insurance companies for some or all of their commercial, Medicaid and Medicare members. The Company also contracts with state and local governmental agencies for the provision of such services to Medicaid recipients. The Company offers its radiology benefits management services through risk-based contracts, where the Company assumes all or a substantial portion of the responsibility for the cost of providing diagnostic imaging services, and through ASO contracts, where the Company provides services, such as utilization review and claims administration, but does not assume responsibility for the cost of the imaging services. As of December 31, 2012, covered lives for Radiology Benefits Management were 4.8 million and 12.4 million for risk-based and ASO products. The Company's radiology benefits management services are provided by a network of providers including diagnostic imaging centers, radiology departments of hospitals that provide advanced imaging services on an outpatient basis, and individual physicians or physician groups that own advanced imaging equipment and specialize in certain specific areas of care.
Drug Benefits Management
Two of the Company's segments are in the drug benefits management business. This line of business generally reflects the Company's clinical management of drugs paid under medical and pharmacy benefit programs. The Company's services include the coordination and management of the specialty drug spending for health plans, employers, and governmental agencies, and the management of pharmacy programs for Medicaid programs, health plans, and employers. The two segments in this line of business are: Specialty Pharmaceutical Management and Medicaid Administration. The Specialty Pharmaceutical Management segment consists of programs that manage specialty drugs used in the treatment of complex conditions, such as cancer, multiple sclerosis, hemophilia, infertility, rheumatoid arthritis, chronic forms of hepatitis and other diseases. The Company's specialty pharmaceutical management services are provided under contracts with health plans, insurance companies, employers, and governmental agencies for some or all of their commercial, Medicare and Medicaid members. The Company's specialty pharmaceutical services include contracting and formulary optimization programs, specialty pharmaceutical dispensing operations, and medical pharmacy management programs.
The Company’s Medicaid Administration segment generally reflects integrated clinical management services provided to manage pharmacy, mental health, and long-term care for state benefit programs, and pharmacy benefit management programs for health plans and employers. The primary focus of the Company's Medicaid Administration unit involves providing pharmacy benefits administration (PBA) and pharmacy benefits management (PBM) services under contracts with health plans and employers, as well as public sector clients sponsoring Medicaid and other state benefit programs. The Company's pharmacy services include network management, formulary and rebate management, point-of-sale claims processing systems and administration, clinical prior authorization, and drug utilization review. Medicaid Administration's contracts encompass both Fee-For-Service (FFS) and risk-based arrangements.
The Company’s Corporate segment consists of operational support functions and corporate support functions. Operational support functions include sales and marketing and information technology. corporate support function include executive, finance, human resources and legal.
Magellan Health Services Inc
55 Nod Road
AVON CT 06001