While US markets make new highs, the S&P managed care index is half the level it was a year ago. We talk to Kevin Fischbeck about what's driven the substantial weakness and whether deterioration in medical loss ratios (MLR) is temporary or something that will last and prevent these companies from recapturing past margins. Kevin also discusses the different markets served by managed care, from commercial to Medicare Advantage to Medicaid and how profitability challenges are likely to last longer for some of these markets than for others. But he also addresses how managed care adds value to each of these settings, delivering care more effectively and cheaply than the alternatives. He notes that vertical integration is still part of the strategy at some managed care companies, and something that can still help to better align incentives, but that it's been overshadowed by challenges faced elsewhere in the business.

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