While Wall Street has focused on the obvious pick-ups in Medicare and Medicaid business that Aetna's purchase of Coventry Health Care will generate, there may also be gems in the commercial treasure chest that Coventry opens to its bigger rival.

The $5.7 billion deal combines the nation's third-largest carrier (Aetna) with the nation's 10th-largest and boosts Aetna's share of revenues based on government business from 23 percent to 30 percent?fitting since the market is clearly headed that way with healthcare reform. The purchase of Coventry, which should be complete in 2013, will add some 3.4 million medical members to Aetna's 18 million-member base.

After the recent merger announcements between Cigna and HealthSpring and WellPoint and Amerigroup Corp., part of the appeal for Aetna may have been that Coventry was still available. But there were also ways the two companies may fit together that will help Aetna compete more strongly come 2014 when the major provisions of healthcare reform are in place.

For one thing, Coventry is more entrenched in the small-group and individual markets than is Aetna, which has typically been more of a national and large-group carrier. The small-group and individual sectors will help feed the new state exchanges.

In addition, though Aetna is a national carrier, it has some geographic holes. Some of them are currently filled by Coventry in markets such as St. Louis, Kansas City and Pittsburgh. On a state basis, there is overlap between the two companies in four of the top 10 markets for each. In one of those, Pennsylvania, Aetna has played stronger in the eastern part of the state, while Coventry's HealthAmerica plan has played well in the Pittsburgh market.

Aetna typically is the No. 3 or No. 4 health plan in most states, playing behind UnitedHealthcare and WellPoint and sometimes running neck and neck with Cigna. In the huge Florida market, Aetna is currently No. 4 in size, but would move into the No. 3 position ahead of Humana after the purchase is complete, according to HealthLeaders-InterStudy data. It would become No. 2 in Pennsylvania, just behind Highmark, and in Missouri, it would become the largest carrier?ahead of United, WellPoint, Blue Cross Blue Shield of Kansas City and Cigna.

The additional 4 million medical members and 1.5 million Medicare Part D members from Coventry give Aetna even greater leverage in negotiating contracts with providers and more markets in which to assemble accountable-care communities based on market-share clout.

As the country hurtles toward government-forced or privately engineered reform, it looks now as though Aetna will have a place at the table, even if it's at the place with the third-biggest slice of pie.

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