Anthem is reporting $1.3 billionin net income for the first quarter on $22 billion in revenue,compared with $1 billion in net income on $22 billion in revenuefor the first quarter of 2017. (Photo: Diego M. Radzinschi/THENATIONAL LAW JOURNAL.)

Cigna Corp. held its annual meeting this week.

Two things are clear.

One is that just how well, or poorly, the individual andsmall-group major medical insurance markets are doing ishazy.

Another is that executives at big health insurance companies are not talkingin much detail about how they might go about selling commercialhealth coverage to individuals and small employers.

Managers of companies that sell insurance products such asannuities and supplemental health benefits have been talkingabout agents and brokers. Managers of the Affordable Care Act public health insuranceprograms have been talking about agents and brokers.

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Executives at the big health insurance companies are focusing onhow they'll help improve the quality and efficiency of the healthcare system.

Here's a look at some of what the companies and the companies'executives have said this week, drawn from earnings releases,earnings conference call recordings and, in Cigna's case,slidedecks created for Cigna's annual meeting.

1. Anthem Inc.

Anthem is reporting $1.3 billion in net income for the firstquarter on $22 billion in revenue, compared with $1 billion in netincome on $22 billion in revenue for the first quarter of 2017.

The company ended the quarter providing or administeringhealth coverage for 37 million people, or 2.5 percent fewer peoplethan it was covering a year earlier.

Enrollment in the company's Medicare plans increased 16 percent,to 1.7 million.

Enrollment in Anthem Medicaid plans fell 1.8 percent, to6.4 million.

Enrollment in local group plans fell 0.3 percent, to about16 million.

The number of people with individual commercial major medicalcoverage fell to 755,000, from 1.9 million.

The drop in the number of individual major medical policyholderswas due mainly to company decisions to drop out of somestates' Affordable Care Act public exchange programs,executives said.

Another figure of interest to agents and brokers, “sellingexpense,” fell 8.9 percent, to $318 million.

Gail Boudreaux, Anthem's president, talked briefly, during acompany conference call with securities analysts, aboutthe idea that the company wants to sell healthinsurance.

Boudreaux said that the company has set up a new saleseffectiveness organization to help the company drive commercialsales while maintaining a disciplined approach to pricing.

She also said that the company will compete harder for thebusiness of employers that want to self-insure, and that shebelieves the company's strong brand reputation will help winself-insured employers back.

Boudreaux did not use the words “agent,” “broker,”“distribution” or “consulting” during the call.

John Gallina, the company's chief financial officer, said thecompany's individual major medical business “actually did a littlebit better than expected.”

“The strategy that we employed with our reduced footprint isactually playing out extremely well, and that helped,” Gallinasaid.

2. Centene Corp.

Centene, which is best known as a Medicaid plan manager, isreporting $338 million in net income for the first quarter on $13billion in revenue, compared with $139 million in net income on $12billion in revenue for the first quarter of 2017.

The St. Louis-based company ended the quarter providing ormanaging health coverage for 13 million people, up from 12 millionpeople a year earlier.

The number of people with the company individual major medicalcoverage increased to 2.2 million, from 1.9 million.

Centene has been active in selling individual major medicalcoverage through the ACA public exchange system. Centene's ACApublic exchange plan enrollment increased to 1.6 million, from 1.2million.

For typical commercial health coverage issuers, coping withthe severe health problems of many people with ACA exchange plancoverage was a shock.

For Centene, which has been used to dealing with the manyMedicaid plan enrollees who have severe healthproblems, adding exchange plan enrollees has helped bring downthe ratio of benefits to revenue. The company's health benefitsratio fell to 84.3 percent in the latest quarter, from87.6 percentin the year-earlier quarter, thanks to exchangeplan enrollment growth, the company said.

Michael Neidorff, Centene's chairman, declined to say much abouthis company's expectations for 2019, but he said he believes anychanges could be good for Centene.

“We believe it is unlikely that Congress will pass health carelegislation in 2018,” Neidorff said. “We see any health carerelated changes being done via regulation.”

The Trump administration recently completed the individual majormedical and ACA exchange parameters regulations for 2019,and Centene believes it can handle the changes included in thoseregulations, Neidorff said.

Regulators in Washington state have questioned the adequacyof the company's exchange plan networks there. Neidorff notedduring the conference call that the company has retained about80 percent of its 2017 exchange plan enrollees this year.“That's pretty good for any kind of commercial product,” Neidorffsaid. “It says that some things were being done right.”

Centene executives did not mention insurance agents, consultantsor brokers during the call.

One of the Centene executives on the call was Kevin Counihan. In the past, Counihan was the head ofConnecticut's ACA public exchange program. He later led the publicexchange team at the Centers for Medicare and MedicaidServices.

3. Cigna Corp.

Cigna Corp. today posted copies of two annual meeting slidedecks,and one set of annual meeting talking points, on the website of theU.S. Securities and Exchange Commission.

David Cordani, the company's president, and Cigna, focusedmainly on talking about the company's pending acquisition ofExpress Scripts, a large pharmacy benefits manager.

In the documents, Cordani and the company talk about matterssuch as helping the United States control health care costsand improve people's health, by tackling problems such as opioidabuse. They do not talk about health coverage sales or marketingstrategies.