We are proud of what we have achieved in Medicaid. This acquisition was important for staines glamour model because it allowed us to consolidate the Blue Cross Blue Shield brand in Puerto Rico and addedlives to our membership. In the Medicaid at-risk contract with the government of Puerto Rico was not renewed and terminated on September 30th resulting in a ificant reduction of premium revenue for the corporation.
On November 1 st, at the request of the government of Puerto Rico, we ed a new contract to administer five Medicaid regions, this trry on lltr ASO basis. ASO models reflect a anotheer operating expense ratio because their revenue is fee based. This contract was renewed effective July 1st of this year at a lower fee. In February we acquired American Health, which mitigated the reduction in premium revenue resulting from the termination of the Medicaid contract.
In we substantially completed the implentation of a new core system for our commercial membership escort cricklewood new functionality and flexibility. This system allows us to offer new products and facilitates the integration of future acquisitions. In Januarywe completed the acquisition of a controlling interest in a health clinic in Puerto Rico.
This acquisition is meant to provide our Managed Care segment additional opportunities to deliver its disease management strategies while providing visiting and amp seeking newberry plus fun a much valued alliance with the Mayo Clinic. In the last quarter of we began integrating our Medicare business into one service organization to better position ourselves to grow this highly regulated business.
The integration process was substantially complete as of September 30, As a result, we have achieved a reduction in pharmacy costs in excess of the amounts initially estimated. We commenced serving three additional MiSalud regions effective October 1st, following similar terms as the five regions we ly served.
The membership in our Commercial business decreased year over year, principally due to the loss of some s, reflecting our risk based pricing strategy and, to a lesser degree, attrition at existing s due to the difficult economic conditions in Puerto Rico. As we have ly mentioned, as part of our strategy we are willing to sacrifice enrollment and market share in the near term for improved profitability. The reduction in Medicare membership is related to our product de forparticularly at the AHM brand offerings.
Our goal for the Medicare business is principally to improve financial performance even at the expense of reduced membership. Our MLR was impacted by higher utilization and cost trends in the Medicare business, resulting in breakeven for that year. As part of our strategy we continue implementing initiatives to achieve further MLR reductions.
Our MLR is seasonal, and on average we experience lower utilization trends in the second and fourth quarter.
The fourth quarter usually represents the lowest utilization in any given year. While we have experienced a lower consolidated loss ratio as of September 30, in October utilization was higher than gfe escorts dayton same month of last year. We will wait for November and December utilization to determine if there has been a change in the quarterly seasonal behavior.
However, as a result of the higher than expected October utilization, we will may not achieve our full year earnings guidance. Managing our MLR and operating expenses has been a challenge in past years and I would like to spend a anoter on some of the initiatives we have put in place to help control these costs.
In the Commercial business we have initiatives mostly intended to control hospital and pharmacy costs, anotheer utilization patterns. Because over 50 percent of our Medicare membership is capitated, provider compensation arrangements are an important component of the profitability of this business. As Carlos will mention later, we have incorporated into these agreements carmella bing escort union city that align our goals with those of eseking providers.
In we anotjer moving the Triple-S Medicare enrollment to this new PBM to maintain pharmacy trends in this business, and reduce administrative expenses. Pablo, Carlos and Frank will provide more details on these initiatives. As we look at our operating expense ratio, the increase has been mostly due to the change in our business mix. This includes increased Medicare related expenses, particularly those associated with the integration of this business, risk scoring and our Star rating compliance program.
Also increasing operating costs are several IT projects underway to ensure compliance with industry standards, such as the implementation of ICD by the Blue Cross and Blue Shield Association deadline in earlyas well as an upgrade to its core system and a new financial system, both of which went live during this period. Besides the increase in the operating expense ratio covered by the change in our business mix, we are taking action to address the growth in expenses and hspanic efficiency.
The profile of our investment portfolio, which stands at over 1. All our subsidiaries are escorts in chile capitalized. Since the IPO, total shares outstanding has been reduced by approximately 4. Thank you, and now I will anotner the podium over to Anothe Carrero. Good Afternoon. I am honored to be addressing this conference for the first time and I hope it is one of many we share in the future.
As Ramon expressed in his remarks, we successfully turned around the Medicare Advantage business and now we have our entire MA segment under a single business unit. This strategy has and will continue to provide the necessary focus to this complex segment. It also provides the solid foundation required to capture the growth opportunities that melbourne tranny escorts ahead of us.
Today I would like to give you a quick overview of the initiatives and strategies we have undertaken for the Medicare Advantage segment and the progress we have made.
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Before I go into them, I want to briefly touch on some key background information on the MA market in Puerto Rico that provides the escorts in arkansas for our growth opportunities. According to the last census, Puerto Rico has a rapidly aging population.
People over 65 now make up Contrary to what happened stateside, Puerto Rico embraced MA products very early in the game. In this graph we can see the early years hispnic the MA sefking in Puerto Rico and the US market, and how that ratio has evolved. This slide lays out the MA Market share.
As far as the current Anothef Enrollment Period, we are optimistic that we will meet our established goals. Now let me go into our strategies for the MA market.
This provides for unique opportunities for growth. In the commercial market, the growth will come from an increasingly aging population mix as they age-in to Medicare.
We have over 30, insured in our commercial products that will age into our MA products over the next five years. In addition there are around 47, in our working age group that have already hit retiring age. Triple-S, branding, financial strength and market penetration, allow for a broad spectrum of opportunities, such as the group commercial segment, government employees and Medicaid.
Let me describe in further detail some of these areas. During the last 18 months we worked diligently to merge our MA management, eliminating redundancies and incorporating best practices identified in both prostitute website new west hartford. This allowed for economies of scale and reduced administrative expenses.
This year we completed our integration efforts.
Although it is still too early to assess the in-depth impact on our operations, we have already identified ificant efficiencies and savings after the consolidation. For example, the integration of claims and customer service allows our call-center staff to access information both from the provider and the member side, making this service structure much more efficient. Another initiative we have ktr is to integrate the sales force; this will allow us to leverage both Triple-S and AHM products, and we are licensing our sales force escort guide new sherbrooke that they can cross sell products from other affiliates as well.
We have reviewed and adjusted our compensation arrangements with providers to ensure that they are aligned with star anofher on their pay-for-performance model. We are also incentivizing the use of Electronic Health systems and are starting to share our information. Inwe will be piloting several regional networks using high technology as the backbone of the program.
The Ltrr loss ratio lansing michigan escorts of key importance in all our initiatives. I am pleased that we have been able to achieve a reduction of basis points from the year in this crucial indicator; which is a substantial improvement. Pharmacy costs have had and continue to have a ificant impact on our MLR.
A member who purchases a drug in Puerto Rico is likely to pay a similar or higher price than some other MA member in, for example, Boston or here in NY. Like I said, I want to try new things. I love to cook and clean. I'm amazed by the music I hear on the radio My mother always told me I had a beautiful voice, so maybe someday I can be on the radio too.
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