The last big leap UCare took came in 1998, when it began offering Medicare Advantage plans to seniors 65 and older.
It marked the organization’s first push outside of its roots of serving a low-income market. In many ways, it was a bolder move for the organization than selling commercial plans on MNsure, Feldman said, as UCare hired a sales force to market the Medicare plan. The organization also lost $16 million on the program in its first three years.
But the strategy worked and in 2008, UCare expanded its Medicare coverage into Wisconsin. Today UCare’s business is about 60 percent from state-based public programs, such as Medical Assistance and MinnesotaCare, and 40 percent from federal Medicare plans.
Ghita Worcester, UCare’s senior vice president of public affairs and marketing, said developing health plans to sell on the exchange was a logical next step. UCare is aiming at two groups — people who move in and out of public programs as their jobs and income change, and couples where one person is covered by a Medicare plan and the other is too young.
“We didn’t do it to diversify our member base,” Worcester said. “It was an extension of who we’ve always been.”
Still, the changes are apparent. Up until 2005, the company grew mainly by word-of-mouth. But UCare has slowly ramped up marketing. It is advertising jointly with Fairview, which operates the University of Minnesota Medical Center, and is running ads to attract a younger audience on the Current (89.3 FM).
With challenges ahead, Feldman said she feels confident about the organizational structures in place. She keeps the tiara where she can see it, and turns to wisdom found in “The Hitchhiker’s Guide to the Galaxy,” the comic science fiction series of books. To her staff, she hands out signs from the series that say: Don’t panic.
Nonprofit 100, by the numbers
Overall revenue for the Nonprofit 100 rose 6.7 percent to $50.27 billion in 2012, up from $47.14 billion in 2011. Expenses rose 6.6 percent to $48.3 billion.
Three of the four categories saw revenue rise year-over-year — health care, social services and education. Revenue at arts and culture organizations fell 6.8 percent.
“These largest nonprofits are an economic force in their own right — and for the most part develop reliable revenue streams and plans for continued growth,” said Jon Pratt, director of the Minnesota Council of Nonprofits, a St. Paul-based nonprofit that tracks the industry.
Health care nonprofits, including insurers like Blue Cross and Blue Shield and health care providers like the Mayo Clinic, accounted for 92 percent of the revenue on our 2012 list, the same as in 2011.
Education groups, including private colleges, universities and prep schools, account for the next-biggest portion with about 5 percent of revenue. Social services and arts and culture nonprofits account for the remaining 3 percent.
Health care and education organizations traditionally are the most recession-resistant types of nonprofits, in part because demand for their services tends to remain steady and they can pass along costs by raising fees and tuition.
Passage of the Affordable Care Act, with its emphasis on expanding coverage and cost controls, has the potential to change that trend in the future. In 2012, health care nonprofits spent about 97.9 cents in expenses for every $1 of revenue, slightly more than 2011.
“If there are more people with health care coverage, then there’s more total revenue and future growth’’ for providers, Pratt said.
Education nonprofits spent 95 cents on expenses for every dollar of revenue they took in during 2012 — about the same as last year.