More health care mergers coming to L.A., analysts say.

The wave of HMO consolidations that had Blue Shield of California acquiring CareAmerica Health Plans last week is expected to continue - with three Los Angeles-area HMOs emerging as prime acquisition targets, analysts said last week.

L.A.-based Maxicare California, Signal Hill-based Universal Care and Inglewood-based United Health Plan are likely to be acquired unless they can engineer mergers or acquisitions of their own, said Steve Valentine, president of The Camden Group, an El Segundo-based health care consulting company.

"They're likely to have to do something, because they're big players but they're not big enough to compete with the bigger players," he said.

Peter Boland, president of Boland Healthcare Inc., a Berkeley-based publisher of health care trade publications, said that if HMOs such as those are taken over, it will most likely be by out-of-state companies seeking a larger share of the California health care market.

Layoffs would be a part of those deals, Boland said - particularly in areas such as marketing, claims management, information systems and executive management where the companies would have redundant operations.

San Francisco-based Blue Shield announced last week that it is buying Woodland Hills-based CareAmerica Health Plans and CareAmerica Life Insurance Co. for $175 million.

Under the terms of the agreement, which is subject to the approval of state and federal regulators, CareAmerica Health Plans would be convened from a for-profit health maintenance organization to a non-profit. The combined company will have nearly 2 million members.

Representatives of Blue Shield and CareAmerica said they do not yet know how many layoffs will occur as a result of their announcement last week.

"We haven't even had the first discussion on that. It's way too premature," said Ross Goldberg,.a senior vice president with CareAmerica. "There have not been any integration meetings yet."

Two of California's largest HMOs, Foundation Health Corp. and Woodland Hills-based Health Systems International, merged earlier this year. The combined company has about 5 million members - half of them in California.

Also, this spring, Cypress-based PacifiCare Health Systems Inc. bought Fountain Valley-based FHP International Corp. The two companies have about 4 million members, with 1.4 million of them in Southern California.

Non-profit Kaiser Permanente - which in June announced that it will combine oversight of its Northern and Southern California operations in Oakland - remains the largest managed care provider in California. It has more than 5 million members in the state, with about 2.3 million of them in Southern California.

Boland said that Kaiser will continue to dominate the California HMO industry.

"Basically, you're going to have Kaiser and you're going to have one or two alternatives to Kaiser," Boland said. "So the real battle is over who's going to get the second and third slots or, over time, that second slot."