EX-99.1 2 exhibit99_1.htm PRESS RELEASE 2012 Q1 Earnings Press Release

151 Farmington Avenue
Hartford, Conn. 06156
Media Contact:
Cynthia Michener
860-273-8553
michenerc@aetna.com
 
Investor Contact:
Tom Cowhey
860-273-2402
cowheyt@aetna.com
 

News Release _________________________________________________________

AETNA REPORTS FIRST-QUARTER 2012 RESULTS

First-quarter 2012 operating earnings per share (1) were $1.34
Net income per share was $1.43
Total medical benefit ratio was 81.5 percent in the first quarter 2012
Medical membership totaled 17.9 million members at March 31, 2012
Aetna reaffirms full-year 2012 projected operating earnings per share of approximately $5.00 (2)

HARTFORD, Conn., April 26, 2012 - Aetna (NYSE: AET) today announced first-quarter 2012 operating earnings (1) of $477.4 million, or $1.34 per share. This operating result compares to the $1.14 per share reported in the first quarter of 2011, excluding the impact of favorable prior-years reserve development in 2011. The increase in first-quarter 2012 operating earnings excluding prior-years development is a continuation of our strong operating performance and the positive momentum in our core business. First-quarter 2011 operating earnings including favorable prior-years reserve development of approximately $112 million were $1.43 per share. There was no significant prior-years reserve development in the first quarter of 2012. Net income for the first quarter of 2012 was $511.0 million, or $1.43 per share, including $.09 per share of net realized capital gains. Net income for the first quarter of 2011 was $586.0 million, or $1.50 per share, including $.07 per share of net realized capital gains.

First-Quarter Financial Results at a Glance
 
 
 
 
(Millions, except per share results)
2012

2011

Change

Revenue (3)
$
8,864.1

$
8,348.1

6
 %
Operating earnings
477.4

560.2

(15
)%
Net income
511.0

586.0

(13
)%
 
 
 
 
Per share results:
 
 
 
      Operating earnings
1.34

1.43

(6
)%
      Net income
1.43

1.50

(5
)%
 
 
 
 
Weighted average common shares - diluted
356.8

391.2

 
 
 
 
 



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“Our first-quarter results are a good start to the year, and we expect continued strong performance in 2012,” said Mark T. Bertolini, Aetna chairman, CEO and president. “We're balancing growth and profitability, and are confident of our ability to increase membership over the course of this year to 18.2 million medical members. We're seeing positive momentum in our 2013 selling season with early National Accounts wins and new business opportunities that are twice what they were a year ago. Customers are beginning to return to Aetna's integrated solutions that deliver better value and health outcomes.

“Aetna also is taking concrete steps toward our long-term goal of making health care more accessible and affordable. Already this year, we launched our consumer digital platform to give people a personalized, coherent experience to manage their health. We also were privileged to be awarded Medicaid contracts in Missouri and Ohio to help their at-risk populations access high-quality, cost-effective care,” said Bertolini.

“Aetna's results in the first quarter are evidence of the rigor with which we manage our business,” said Joseph M. Zubretsky, Aetna senior executive vice president and CFO. “In addition to strong commercial underwriting margins, Aetna posted 6 percent year-over-year revenue growth. Our financial position, capital structure, and liquidity all continue to be very strong.

“We're executing on the core business and expanding our emerging business, where we're advancing our goal of transforming the network model to address the nation's health care cost and quality challenges. Our fast-growing base of opportunities with health systems around the country reflects the value that providers see in Aetna's Accountable Care Solutions business. We believe Aetna's strategy to invest in innovation that improves health care delivery and to capitalize on opportunities for profitable growth will enable us to continue generating operating earnings growth,” said Zubretsky.




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Health Care business results
Health Care, which provides a full range of insured and self-insured medical, pharmacy, dental and behavioral health products and services, reported:
Operating earnings of $468.9 million for the first quarter of 2012, compared with $443.4 million, excluding the impact of favorable prior-years reserve development for the corresponding period in 2011. This increase in first quarter 2012 operating earnings was primarily due to higher Medicare Advantage underwriting margins. Operating earnings in the first quarter of 2011, including the impact of approximately $112 million after tax of favorable prior-years reserve development, were $555.3 million. There was no significant prior-years reserve development in the first quarter of 2012.
Revenues (3) of $8.20 billion for the first quarter of 2012, compared with $7.71 billion for the first quarter of 2011. The increase is due to higher Health Care premium primarily from higher Commercial premium yields, higher Medicare premium from Medicare Advantage membership growth and the addition of Genworth's Medicare Supplement business, and higher fees and other revenue primarily from the inclusion of revenues from our other 2011 acquisitions. Total Revenue for the first quarter of 2012, which includes net realized capital gains, was $8.24 billion compared with $7.74 billion for the first quarter of 2011.
Medical benefit ratios (MBRs) for the first quarters of 2012 and 2011 were as follows:
 
2012

 
2011

 
Commercial
79.9
%
 
77.0
%
(b) 
Medicare
84.4
%
 
85.1
%
(c) 
Medicaid
91.6
%
 
88.5
%
(d) 
Total
81.5
%
 
79.2
%
(a) 
 
 
 
 
 
(a)  
Excluding favorable development of prior-years health care cost estimates of approximately $174 million before tax, the Total MBR was 81.8 percent for the first quarter of 2011.
(b)  
Excluding favorable development of prior-years health care cost estimates of approximately $143 million before tax, the Commercial MBR was 79.8 percent for the first quarter of 2011.
(c)
Excluding favorable development of prior-years health care cost estimates of approximately $25 million before tax, the Medicare MBR was 86.8 percent for the first quarter of 2011.
(d)  
Excluding favorable development of prior-years health care cost estimates of approximately $6 million before tax, the Medicaid MBR was 90.4 percent for the first quarter of 2011.




Aetna/4

Sequentially, first-quarter 2012 medical membership decreased by 544,000 to 17.915 million, reflecting previously projected decreases in our Commercial administrative services contract membership and our exit from the Connecticut Medicaid program, partially offset by growth in other businesses; dental membership decreased by 57,000 to 13.613 million and pharmacy benefit management services membership decreased by 177,000 to 8.643 million.
Net income was $495.9 million for the first quarter of 2012, compared with $577.2 million for the first quarter of 2011.

Group Insurance business results
Group Insurance, which includes group life, disability and long-term care products, reported:
Operating earnings of $40.9 million for the first quarter of 2012, compared with $42.9 million for the first quarter of 2011.
Net income of $48.8 million for the first quarter of 2012, compared with $47.1 million for the first quarter of 2011.
Revenues (3) of $532.0 million for the first quarter of 2012, compared with $504.4 million for the first quarter of 2011. First-quarter Total Revenue, which includes net realized capital gains, was $544.2 million in 2012 and $510.9 million in 2011.

Large Case Pensions business results
Large Case Pensions, which manages a variety of discontinued and other retirement and savings products, primarily qualified pension plans, reported:
Operating earnings of $5.8 million for the first quarters of both 2012 and 2011.
Net income of $4.5 million for the first quarter of 2012, compared with $5.5 million for the first quarter of 2011.

Total company results
Revenues (3) for the first quarter of 2012 were $8.86 billion, compared with $8.35 billion for the first quarter of 2011. The increase is primarily the result of higher Health Care premium and higher fees and other revenue. Total Revenue, which includes net realized capital gains, was $8.92 billion and $8.39 billion for the first quarters of 2012 and 2011, respectively.



Aetna/5

Operating Expenses (1) were $1.67 billion for the first quarter of 2012. The business segment operating expense ratio (4) was 18.8 percent in the first quarter of 2012 and 18.7 percent in the first quarter of 2011. Including net realized capital gains, these ratios were 18.7 percent and 18.6 percent for the first quarters of 2012 and 2011, respectively.
Corporate Financing Interest Expense was $38.5 million and $43.0 million after tax for the first quarters of 2012 and 2011, respectively.
Net Income was $511.0 million for the first quarter of 2012 compared with $586.0 million for the first quarter of 2011.
Pre-tax Operating Margin (5) was 9.4 percent for the first quarter of 2012 compared with 11.4 percent for the first quarter of 2011. For the first quarter of 2012, the after-tax net income margin was 5.7 percent compared to 7.0 percent for 2011.
Share Repurchases totaled 7.4 million shares at a cost of $344 million in the first quarter of 2012.

Aetna's conference call to discuss first-quarter 2012 results will begin at 8:30 a.m. ET today. The public may access the conference call through a live audio webcast available on Aetna's Investor Information link on the Internet at www.aetna.com. Financial, statistical and other information, including GAAP reconciliations, related to the conference call also will be available on Aetna's Investor Information website.

The conference call also can be accessed by dialing 800-967-7135 or +1-719-457-2710 for international callers. The company suggests participants dial in approximately 10 minutes before the call. The access code is 1470071. Individuals who dial in will be asked to identify themselves and their affiliations.

A replay of the call may be accessed through Aetna's Investor Information link on the Internet at www.aetna.com or by dialing 888-203-1112, or +1-719-457-0820 for international callers. The replay access code is 1470071. Telephone replays will be available from 11 a.m. ET on April 26, 2012, until 11 p.m. ET on May 10, 2012.




Aetna/6

About Aetna
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.1 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities, Medicaid health care management services and health information technology services. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.





Aetna/7


Consolidated Statements of Income
 
 
 
 
 
For the Three Months
 
March 31,
(Millions)
2012
 
2011
Revenue:
 
 
 
Health care premiums
$
7,187.4

 
$
6,750.6

Other premiums
476.4

 
445.3

Fees and other revenue
959.7

 
899.6

Net investment income
240.6

 
252.6

Net realized capital gains
51.7

 
39.7

            Total revenue
8,915.8

 
8,387.8

 
 
 
 
Benefits and expenses:
 
 
 
Health care costs
5,857.5

 
5,348.0

Current and future benefits
510.9

 
485.5

Operating expenses:
 
 
 
      Selling expenses
285.8

 
290.7

      General and administrative expenses
1,380.2

 
1,272.8

            Total operating expenses
1,666.0

 
1,563.5

Interest expense
59.3

 
66.1

Amortization of other acquired intangible assets
37.8

 
26.3

            Total benefits and expenses
8,131.5

 
7,489.4

 
 
 
 
Income before income taxes
784.3

 
898.4

Income taxes
273.3

 
312.4

Net income
$
511.0

 
$
586.0

 
 
 
 






Aetna/8


Summary of Results
 
 
 
 
 
 
 
 
 
For the Three Months
 
Ended March 31,
(Millions)
2012
 
2011
Operating earnings, excluding prior-years development (1)


 
$
448.3

    Favorable development of prior-years health care cost estimates


 
111.9

Operating earnings
$
477.4

 
560.2

      Net realized capital gains
33.6

 
25.8

Net income (GAAP measure)
$
511.0

 
$
586.0

 
 
 
 
Weighted average common shares - basic
350.3

 
383.5

 
 
 
 
Weighted average common shares - diluted
356.8

 
391.2

 
 
 
 
Per Common Share
 
 
 
Operating earnings, excluding prior-years development (1)


 
$
1.14

    Favorable development of prior-years health care cost estimates
 
 
.29

Operating earnings
$
1.34

 
1.43

      Net realized capital gains
.09

 
.07

Net income (GAAP measure)
$
1.43

 
$
1.50






Aetna/9


Segment Information (6)
 
 
 
 
 
For the Three Months
 
Ended March 31,
(Millions)
2012
 
2011
Health Care:
 
 
 
Revenue, excluding net realized capital gains
$
8,201.1

 
$
7,709.7

      Net realized capital gains
41.6

 
33.7

Total revenue (GAAP measure)
$
8,242.7

 
$
7,743.4

 
 
 
 
Commercial Medical Benefit Ratio: (1)
 
 
 
Premiums
$
5,177.1

 
$
5,013.6

Health care costs (GAAP measure)
$
4,135.0

 
$
3,859.4

       Favorable development of prior-years health care cost estimates
 
 
142.7

Health care costs, excluding prior-years development
 
 
$
4,002.1

 
 
 
 
Commercial MBR (GAAP measure)
79.9
%
 
77.0
%
Commercial MBR, excluding prior-years reserve development
 
 
79.8
%
 
 
 
 
Medicare Medical Benefit Ratio: (1)
 
 
 
Premiums
$
1,651.6

 
$
1,408.8

Health care costs (GAAP measure)
$
1,393.9

 
$
1,198.3

      Favorable development of prior-years health care cost estimates
 
 
24.5

Health care costs, excluding prior-years development
 
 
$
1,222.8

 
 
 
 
Medicare MBR (GAAP measure)
84.4
%
 
85.1
%
Medicare MBR, excluding prior-years reserve development
 
 
86.8
%
 
 
 
 
Medicaid Medical Benefit Ratio: (1)
 
 
 
Premiums
$
358.7

 
$
328.2

Health care costs (GAAP measure)
$
328.6

 
$
290.3

      Favorable development of prior-years health care cost estimates
 
 
6.3

Health care costs, excluding prior-years development
 
 
$
296.6

 
 
 
 
Medicaid MBR (GAAP measure)
91.6
%
 
88.5
%
Medicaid MBR, excluding prior-years reserve development
 
 
90.4
%
 
 
 
 
Total Medical Benefit Ratio: (1)
 
 
 
Premiums
$
7,187.4

 
$
6,750.6

Health care costs (GAAP measure)
$
5,857.5

 
$
5,348.0

      Favorable development of prior-years health care cost estimates
 
 
173.5

Health care costs, excluding prior-years development
 
 
$
5,521.5

 
 
 
 
Total MBR (GAAP measure)
81.5
%
 
79.2
%
Total MBR, excluding prior-years reserve development
 
 
81.8
%
 
 
 
 
Operating earnings,(1) excluding prior-years development


 
$
443.4

      Favorable development of prior-years health care cost estimates


 
111.9

Operating earnings
$
468.9

 
555.3

      Net realized capital gains
27.0

 
21.9

Net income (GAAP measure)
$
495.9

 
$
577.2

 
 
 
 



Aetna/10


Segment Information continued (6)
 
 
 
 
 
For the Three Months
 
Ended March 31,
(Millions)
2012

 
2011

 
 
 
 
Group Insurance:
 
 
 
Revenue, excluding net realized capital gains
$
532.0

 
$
504.4

      Net realized capital gains
12.2

 
6.5

Total revenue (GAAP measure)
$
544.2

 
$
510.9

 
 
 
 
Operating earnings
$
40.9

 
$
42.9

      Net realized capital gains
7.9

 
4.2

Net income (GAAP measure)
$
48.8

 
$
47.1

 
 
 
 
Large Case Pensions:
 
 
 
Revenue, excluding net realized capital losses
$
131.0

 
$
134.0

      Net realized capital losses
(2.1
)
 
(.5
)
Total revenue (GAAP measure)
$
128.9

 
$
133.5

 
 
 
 
Operating earnings
$
5.8

 
$
5.8

      Net realized capital losses
(1.3
)
 
(.3
)
Net income (loss) (GAAP measure)
$
4.5

 
$
5.5

 
 
 
 
 
 
 
 
 
 
 
 
Total Company:
 
 
 
Revenue, excluding net realized capital gains (A)
$
8,864.1

 
$
8,348.1

      Net realized capital gains
51.7

 
39.7

Total revenue (GAAP measure) (B)
$
8,915.8

 
$
8,387.8

 
 
 
 
Business segment operating expenses (C)
$
1,666.6

 
$
1,562.3

      Corporate Financing segment operating (benefit) expense (7)
(.6
)
 
1.2

Total operating expenses (GAAP measure) (D)
$
1,666.0

 
$
1,563.5

 
 
 
 
 
 
 
 
Operating Expenses Ratios:
 
 
 
Business segment operating expense ratio (C)/(A)
18.8
%
 
18.7
%
Total operating expense ratio (D)/(B) (GAAP measure)
18.7
%
 
18.6
%





Aetna/11


Membership
 
 
 
 
 
 
 
March 31,

 
December 31,

 
March 31,

(Thousands)
2012

 
2011

 
2011

Medical Membership:
 
 
 
 
 
Commercial
16,136

 
16,626

 
16,175

Medicare Advantage
434

 
398

 
395

Medicaid
1,174

 
1,272

 
1,212

Medicare Supplement
171

 
163

 
12

      Total Medical Membership
17,915

 
18,459

 
17,794

 
 
 
 
 
 
Consumer-Directed Health Plans (8)
2,560

 
2,387

 
2,412

 
 
 
 
 
 
Dental Membership:
 
 
 
 
 
Commercial
12,003

 
12,071

 
11,881

Medicare & Medicaid
637

 
652

 
626

Network Access  (9)
973

 
947

 
982

      Total Dental Membership
13,613

 
13,670

 
13,489

 
 
 
 
 
 
Pharmacy Benefit Management Membership:
 
 
 
 
 
Commercial
7,869

 
8,177

 
7,901

Medicare Prescription Drug Plan (stand-alone)
469

 
427

 
447

Medicare Advantage Prescription Drug Plan
198

 
189

 
190

Medicaid
107

 
27

 
27

      Total Pharmacy Benefit Management Services
8,643

 
8,820

 
8,565

 
 
 
 
 
 






Aetna/12



Operating Margins
 
 
 
 
 
For the Three Months
 
Ended March 31,
(Millions)
2012
 
2011
Reconciliation to Income Before Income Taxes:
 
 
 
Operating earnings (1) before income taxes, excluding interest
 
 
 
         expense and amortization of other acquired intangible assets (A)
$
829.7

 
$
951.1

      Interest expense
(59.3
)
 
(66.1
)
      Amortization of other acquired intangible assets
(37.8
)
 
(26.3
)
      Net realized capital gains
51.7

 
39.7

Income before income taxes (GAAP measure)
$
784.3

 
$
898.4

 
 
 
 
Reconciliation to Net Income:
 
 
 
Operating earnings,(1)  excluding interest expense and
 
 
 
         amortization of other acquired intangible assets, net of tax
$
540.5

 
$
620.3

      Interest expense, net of tax
(38.5
)
 
(43.0
)
      Amortization of other acquired intangible assets, net of tax
(24.6
)
 
(17.1
)
      Net realized capital gains, net of tax
33.6

 
25.8

Net income (GAAP measure) (B)
$
511.0

 
$
586.0

 
 
 
 
Reconciliation of Revenue:
 
 
 
Revenue, excluding net realized capital gains (C)
$
8,864.1

 
$
8,348.1

      Net realized capital gains
51.7

 
39.7

Total revenue (GAAP measure) (D)
$
8,915.8

 
$
8,387.8

 
 
 
 
Operating and Net Income Margins:
 
 
 
Pretax operating margin (A)/(C)
9.4
%
 
11.4
%
After-tax net income margin (B)/(D) (GAAP measure)
5.7
%
 
7.0
%
 
 
 
 





Aetna/13


(1) Operating earnings and operating earnings per share exclude from net income net realized capital gains and losses and other items, if any, that neither relate to the ordinary course of our business nor reflect our underlying business performance. Although the excluded items may recur, management believes that operating earnings and operating earnings per share provide a more useful comparison of Aetna's underlying business performance from period to period. Management uses operating earnings to assess business performance and to make decisions regarding Aetna's operations and allocation of resources among Aetna's businesses. Operating earnings is also the measure reported to the Chief Executive Officer for these purposes.

For the periods covered in this press release, the following item is excluded from operating earnings because we believe it neither relates to the ordinary course of our business nor reflects our underlying business performance:
Net realized capital gains and losses arise from various types of transactions, primarily in the course of managing a portfolio of assets that support the payment of liabilities. However, these transactions do not directly relate to the underwriting or servicing of products for customers and are not directly related to the core performance of Aetna's business operations.

This press release also includes presentations of operating earnings, operating earnings per share, health care costs and medical benefit ratios for the three months ended March 31, 2011 excluding development of prior-years health care cost estimates. Management believes these measures provide a useful comparison of Aetna's underlying business performance from period to period where there are significant differences in prior-years development from period to period.

For a reconciliation of these items to financial measures calculated under U.S. generally accepted accounting principles (“GAAP”), refer to the tables on pages 8 through 10 and 12 of this press release.

(2) Projected operating earnings per share exclude from net income any future net realized capital gains and losses and other items, if any, that neither relate to the ordinary course of our business nor reflect our underlying business performance. Aetna is not able to project the amount of future net realized capital gains and losses or any such other items and therefore cannot reconcile projected operating earnings per share to projected net income per share in any period. Projected operating earnings per share for the full year 2012 reflect a range of approximately 350 million to 353 million weighted average diluted shares.

(3) Revenue excludes net realized capital gains and losses as noted in (1) above. Refer to the tables on pages 9, 10 and 12 of this press release for a reconciliation of revenue excluding net realized capital gains and losses to revenue calculated under GAAP.

(4) The business segment operating expense ratio reflects the exclusion of the Corporate Financing segment from operating expenses and excludes net realized capital gains and losses and other items, if any. For a reconciliation of this metric to the comparable GAAP measure refer to page 10 of this press release.

(5) In order to provide useful information regarding Aetna's profitability on a basis comparable to others in the industry, without regard to financing decisions, income taxes or amortization of other acquired intangible assets (each of which may vary for reasons not directly related to the performance of the underlying business), Aetna's pretax operating margin is based on operating earnings excluding interest expense, income taxes and amortization of other acquired intangible assets. Management also uses pretax operating margin to assess Aetna's performance, including performance versus competitors.

(6) Revenue and operating expense information is presented before income taxes. Operating earnings is presented net of income taxes.

(7) Our Corporate Financing segment is not a business segment. It is added to our business segments to reconcile to our consolidated results. The Corporate Financing segment includes interest expense on our outstanding debt and the financing components of our pension and other postretirement benefit plan expenses (benefits).

(8) Represents members in consumer-directed health plans included in Aetna's Commercial medical membership.

(9) Represents members in products that allow these members access to Aetna's dental provider network for a nominal fee.












Aetna/14

CAUTIONARY STATEMENT; ADDITIONAL INFORMATION -- -- Certain information in this press release is forward-looking, including our projections as to operating earnings per share, medical membership, operating earnings growth and weighted average diluted shares. Forward-looking information is based on management's estimates, assumptions and projections, and is subject to significant uncertainties and other factors, many of which are beyond Aetna's control. Important risk factors could cause actual future results and other future events to differ materially from those currently estimated by management, particularly the implementation of health care reform legislation and changes in Aetna's future cash requirements, capital requirements, results of operations, financial condition and/or cash flows. Health care reform will significantly impact our business operations and financial results, including our medical benefit ratios. Components of the legislation will be phased in over the next six years, and we will be required to dedicate material resources and incur material expenses during that time to implement health care reform. Many significant parts of the legislation, including health insurance exchanges, the scope of "essential benefits," employer penalties and the implementation of minimum medical loss ratios, require further guidance and clarification both at the federal level and/or in the form of regulations and actions by state legislatures to implement the law. In addition, the pending U.S. Supreme Court ruling on the constitutionality of health care reform and the 2012 presidential election create additional uncertainty about the ultimate impact of health care reform. As a result, many of the impacts of health care reform will not be known for the next several years. Other important risk factors include adverse and less predictable economic conditions in the U.S. and abroad (including unanticipated levels of, or increases in the rate of, unemployment); adverse changes in health care reform and/or other federal or state government policies or regulations as a result of health care reform or otherwise (including legislative, judicial or regulatory measures that would affect our business model, restrict funding for or amend various aspects of health care reform, limit our ability to price for the risk we assume and/or reflect reasonable costs or profits in our pricing, such as mandated minimum medical benefit ratios, eliminate or reduce ERISA pre-emption of state laws (increasing our potential litigation exposure) or mandate coverage of certain health benefits); our ability to differentiate our products and solutions from those offered by our competitors, and demonstrate that our products lead to access to better quality of care by our members; unanticipated increases in medical costs (including increased intensity or medical utilization as a result of flu, increased COBRA participation rates or otherwise; changes in membership mix to higher cost or lower-premium products or membership-adverse selection; changes in medical cost estimates due to the necessary extensive judgment that is used in the medical cost estimation process, the considerable variability inherent in such estimates, and the sensitivity of such estimates to changes in medical claims payment patterns and changes in medical cost trends; increases resulting from unfavorable changes in contracting or re-contracting with providers, and increased pharmacy costs); failure to achieve and/or delays in achieving desired rate increases and/or profitable membership growth due to regulatory review or other regulatory restrictions, the difficult economy and/or significant competition, especially in key geographic areas where membership is concentrated, including successful protests of business awarded to us; adverse changes in size, product mix or medical cost experience of membership; our ability to diversify our sources of revenue and earnings; adverse program, pricing or funding actions by federal or state government payors, including curtailment or elimination of the Centers for Medicare & Medicaid Services' star rating bonus payments; the ability to reduce administrative expenses while maintaining targeted levels of service and operating performance; the ability to successfully implement our agreement with CVS Caremark Corporation on a timely basis and in a cost-efficient manner and to achieve projected operating efficiencies for the agreement; our ability to integrate, simplify, and enhance our existing information technology systems and platforms to keep pace with changing customer and regulatory needs; the success of our health information technology initiatives; the ability to successfully integrate our businesses (including Medicity, Prodigy Health Group, PayFlex, and Genworth Financial Inc.'s Medicare Supplement business and other businesses we acquire in the future) and implement multiple strategic and operational initiatives simultaneously; managing executive succession and key talent retention, recruitment and development; the outcome of various litigation and regulatory matters, including guaranty fund assessments and litigation concerning, and ongoing reviews by various regulatory authorities of, certain of our payment practices with respect to out-of-network providers and/or life insurance policies; reputational issues arising from our social media activities, data security breaches, other cybersecurity risks or other causes; the ability to develop and maintain relations with providers while taking actions to reduce medical costs and/or expand the services we offer; our ability to maintain our relationships with third party brokers, consultants and agents who sell our products; increases in medical costs or Group Insurance claims resulting from any epidemics, acts of terrorism or other extreme events; and a downgrade in our financial ratings. For more discussion of important risk factors that may materially affect Aetna, please see the risk factors contained in Aetna's 2011 Annual Report on Form 10-K ("Aetna's Annual Report") on file with the Securities and Exchange Commission (the “SEC”) and Aetna's Quarterly Report on Form 10-Q for the quarter ended March 31, 2012 ("Aetna's Quarterly Report") when filed with the SEC. You also should read Aetna's Annual Report and Aetna's Quarterly Report for a discussion of Aetna's historical results of operations and financial condition.