AM Best has downgraded the Financial Strength Rating to B++ (Good) from A- (Excellent) and the Long-Term Issuer Credit Rating to “bbb” (Good) from “a-” (Excellent) of PacificSource Health Plans (Springfield, OR), a subsidiary of Pacific Source Health Group (PHG). The outlook of these Credit Ratings (ratings) is stable.

The ratings reflect PHG’s balance sheet strength, which AM Best assesses as weak, as well as its adequate operating performance, neutral business profile and appropriate enterprise risk management.

The overall balance sheet strength of PHG is assessed as weak, driven largely by its very weak Best’s Capital Adequacy Ratio (BCAR). The very weak BCAR level has persisted year-over-year, as premium growth has outpaced capital expansion. At year-end 2023, and through the first half of 2024, the company has reported strong growth in its absolute capital levels, growing at a five-year compound annual growth rate of over 15% driven by generally favorable underwriting gains, as well as through historical capital infusions a few years ago. Previously, premium leverage ratios were lower due to solid growth in capital outpacing moderate growth in net premiums written, this was combined with capital contributions, which also supported its growth at that time. However, premium leverage has increased significantly as PHG has taken on more premiums across its businesses, primarily in its Medicaid business segment, which has grown by more than 50% over the last five-year period to over $2 billion in net premium written, this represents more than half of PHGs total business. Given PHG’s continued growth in 2024, and the lack of capital injections beyond organic growth from earnings, AM Best anticipates that risk-adjusted capital will continue to be pressured in the near term. Overall, the balance sheet is primarily invested in high-quality fixed-income securities, equities, cash and short-term investments. The insurance organization has no debt and maintains very good liquidity measures.

On an operating performance basis, PHG reported a significant decrease in underwriting income at year-end 2023, which when combined with favorable investment income for the year and minimal realized losses, resulted in a small net loss for the year. The group reported its only other loss over the last five years in 2021, which was more substantive. Profitability has improved through the first half of 2024, but it is expected to remain challenged through year-end 2024, and into 2025. The Medicare Advantage and Medicaid businesses reported decreased underwriting results in 2023, and AM Best expects further challenges in these government market segments in 2024 and beyond, as has occurred across the industry. The Medicaid segment continued to drive profitability, and even with a modest decline, this line still produced over $80 million on an underwriting basis. However, the Medicare Advantage line of business reported a sizeable loss of almost $100 million, which included a large premium deficiency reserve (PDR) set during the period related to its Stars rating reduction and a corresponding reduction in revenue bonus income for 2024. The PDR has been reversed in 2024, driving improved reported results. Nevertheless, it is anticipated that losses in Medicare Advantage will continue into 2025. The commercial business underwriting results rebounded in 2023, and into 2024, largely driven by the group commercial business.

PHG has an established presence in its primary Oregon market and maintains diversity geographically and across its core lines of business in commercial, Medicare Advantage and Medicaid. Additionally, the relationships with its parent organizations, through the partnership of Pacific Health Associates and Legacy Health, have strengthened PHG, by presenting opportunities for the health plan and the health system to strategically coordinate care management programs, as well as regional expansion of product offerings. The integration presents a competitive advantage and drives closer relationships with providers in key geographic regions. AM Best notes that one limiting factor is that it does not appear that Legacy Health is prepared or required to make any additional capital infusions, which could impact future levels of lift if the premium growth continues to outpace organic capital expansion.

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