States are at the center of decisions on how to implement the coverage expansion initiatives of the Affordable Care Act. Some embraced the extension of Medicaid eligibility and built their own health insurance exchanges. Others have rejected the opportunity to bring coverage to low-income households and billions of federal dollars to their safety net providers. And while many credit or blame the ACA for the growth of high deductible health plans or for the growing use of limited provider networks, it seems clear that these are trends that were in progress for many years already.
Our annual market reports and data are an invaluable source of insight into twelve state health care markets. We assemble data on health plans and provider systems and weave that analysis together with the perspectives of leaders in each market. By touring our web site, you can download samples of what is in those reports and data sets.
Through our consulting research, we apply our analysis of local markets to help pharmaceutical companies, health plans, provider organizations, health purchasers, investment firms and government agencies to address the business competition and strategy issues that they face.
- Competitive pressures plus changes in Medicare payment are driving more consolidation for both hospitals and health plans. The Beaumont, Oakwood and Botsford systems closed on their merger in early September - now begins the hard work of blending three large organizations, their cultures and information systems. An earlier attempt to merge the Henry Ford and Beaumont systems collapsed. The entry of Vanguard Health, now part of Tenet, in the Detroit market has resulted in more vigorous competition for a shrinking pie of hospital care. See my data and comments in HealthLeaders and in the Detroit News. Vanguard's experience with Medicare ACOs and operating HMOs may have made it a more attractive acquisition to Tenet Health. Some systems are pursuing other strategies for extending their geographic reach, in some cases going beyond traditional local market boundaries. Read my recent paper on Mayo Clinic's partnerships and what providers like Cleveland Clinic are doing. We are also following the recent health plan and provider group acquisitions made by Aetna, CIGNA, Humana, WellPoint and UnitedHealthcare.
- New coverage options through state exchanges are transforming the individual insurance markets in different states, as new competitors arrives and insurers compete on price and networks. In September 2014 we published a briefing paper entitled: "Growth and Market Share Shifts in Individual Health Insurance Markets." Click here to download a PDF of the paper. A few days later, PreferredOne in Minnesota, which sold the most individual plans on the MNsure exchange, announced it would no longer sell on MNsure and wild speculation ensued on why. See below for links to the coverage.
- Medicaid is now the largest line of business for HMOs in many states and they enjoyed significant, profitable growth in states that expanded eligibility under the ACA, effective January 1, 2014. But are their profits too high?
- Strong profits but risks for hospitals with their ambitious construction projects, seeking to expand their market share and extend their geographic reach. Colorado Public News used my analysis of hospital finances for its article, "Most Colorado hospitals report strong profits for 2010." Peter Frost's article in the Chicago Tribune quotes me on who bears the cost for the billions in new hospital construction underway in that region. But fewer people have comprehensive insurance coverage, and providers are feeling downward pressure on utilization. See my take in dBusiness on the impact of more than a billion dollars in new construction by Vanguard and the other Detroit systems, even as the market for hospital services there is shrinking.
To request a free sample of one of our state reports, click here
Texas Health Market Review 2014 released January 9: "Texas hospital form statewide systems, strategic affiliations; hospital profitability remains very strong, but inpatient use is flat; HMOs gained nearly half a million individual members in 2014."
- Lauren Silverman reported on KERA News: "Billions In Play in North Texas Hospital Building Boom."
- Bill Hethcock @DBJHethcock wrote in the Dallas Business Journal: "Which North Texas hospitals are raking in the revenues?" Also in the Dallas Business Journal: "BaylorScott&White to affiliate with Cleveland Clinic for heart care"
- Mary Ann Moser @maroser wrote in the Austin American-Statesman: "HUD gets $50 million for $164 million Lakeway hospital loan; new report shows that Austin-area hospital were slightly more profitable in 2013 than other Texas hospitals"
- Matt Goodman @goodmoine wrote in DHealthcare Daily: "Here are the most profitable hospitals in North Texas -- and why"
If you skipped 2013 reports for Michigan, Minnesota or Texas, you can order both 2014 and 2013 reports for those states for $225. Click here to order.
Wisconsin Health Market Review 2014 released November 6, 2014: "Milwaukee-Area Hospitals Reports Strongest Profits Though Inpatient Days Decline; Medicaid and Strong Investment Income Boost HMO Profits and Implementation of Health Reform Transforms Individual Insurance Market"
- See coverage in BizTimes.com: Milwaukee Business News: "Report finds Milwaukee-area hospitals earned strongest profits ever"
- "Common Ground led Obamacare enrollments in 2014: Report" by Rich Kirchen in the Milwaukee Business Journal.
Michigan Health Market Review 2014, Part One, released July 14: "HMO Profitability Declines and Medicaid Margins Narrow; Individual Insurance Market Changes and Expands."
- Karen Bouffard wrote in the Detroit News: "Health care overhaul boosts insurance industry, report finds"
- Jay Greene wrote in Crain's Detroit Business: "Michigan health plans struggled in 2013, but see opportunity in 2014"
Minnesota Health Market Review 2014, Part One, released June 20: "Individual Plans Grow and Market Share Shifts; Strong Health Plan Profitability Drives Higher Reserves."
The Big Picture V: New York's Public and Private Insurance Markets, 2012, released May 7, 2014. "Insurance plans specializing in public programs were fastest growing." See the summary here and download the PDF here.
Reports and data sets now available for these states:
Ohio Health Market Review 2013 released December 16: "Consolidated hospital systems enjoy improved profits even as inpatient days decline; Growing Medicare and Medicare plans drive strong HMO profitability"
Florida Health Market Review 2013 was released September 13: "Consolidated hospital systems see profits despite declining utilization; HMO Medicare and commercial plans are strongly profitable"
Supplementary analysis of New York Medicare Advantage plans released July 2014: "New York's Medicare Advantage Market, 2010-2012." Click here for summary and PDF links.
Webinar presentation on September 23, 2014: "Ohio Health Markets: An Update on Plan & Provider Strategies," for the Health Action Council. Click here to download the presentation.
Michigan Health Market Review 2013, Part Two, was released February 24, 2014: "Challenged to Do Better for Less, Michigan Provider Systems Seek Growth and Quality Improvement; Profitability is Strong but Inpatient Utilization Drops Sharply"
Colorado Health Market Review 2013 was released May 30: "Profitability is strong for Colorado hospitals and health plans; Hospital capacity grows but utilization is flat"
lllinois Health Market Review 2012 released December 5, 2012: "Health insurers and hospital enjoy strong profits; inpatient hospital days decline for fourth straight year."
Want to see a sample market study? Several reports are available for free PDF download. Follow the links for:
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