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. In Detroit, 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. 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. The Robert Wood Johnson Foundation just published my new analysis of hospital consolidation and strategic partnerships for provider systems in New Jersey. Read my recent paper on Mayo Clinic's partnerships and what Cleveland Clinic is doing with its national cardiovascular network. My New Jersey report describes how M.D. Anderson Cancer Center is taking these national networks to a new, higher level by opening an M.D. Anderson Cancer Center satellite at Cooper University Medical Center in Camden, NJ and its fourth center at Baptist Hospital in Jacksonville, FL.
- 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 Florida, for example, enrollment in HMO individual plans grew by 900,000 in the past 18 months. 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.
- 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. Recent competitive bid processes in Michigan and Minnesota shut out current contractors UCare and HAP Midwest Health Plan.
- Strong profits but risks for hospitals with their ambitious construction projects, seeking to expand their market share and extend their geographic reach. Lauren Silverman's report for NPR describes how billions are being spent on hospital construction in north Texas and quotes me: "If I were a contractor, I would wake up every morning and thank G-d for the health care business." 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. Even as more people gain individual and Medicaid coverage, inpatient admissions continue to fall in most states. 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
Newest State Market Report:
Florida Health Market Review 2015 was released November 18: "Hospital systems expand and consolidate, report improved profits; HMO Medicaid and individual enrollment surges, but profits drop"
- Sammy Mack reported in Health News Florida: "Negotiating Power Shifts as Hospitals Consolidate" Click here to listen and read
- Charles Elmore wrote in the Palm Beach Post: "Florida HMO Enrollment Jumps 44% to biggest ever, report says" Click here to read
- Nina Lincoff wrote in the South Florida Business Journal: "Hospital network and health plan consolidation expected to continue in Florida" Click here to read
- Margie Manning wrote in the Tampa Bay Business Journal: "Humana leads, WellCare lags among Florida HMOs" Click here to read
- Ron Hurtibise wrote in the SunSentinel: "Hospital profits jump nearly 40%" Click here to read
New Analysis of Provider System Strategies in New Jersey
"Recent Changes in Primary Care Delivery and Health Provider Systems in New Jersey" published by the Robert Wood Johnson Foundation, June 2015. "The trend toward consolidation of providers is likely to continue and the importance of the strategic alliances is likely to grow." Click here for a summary and to download the report and special data sets on hospitals and convenient care clinics in the state. Local coverage:
Andrew @Kitchenman wrote in NJSpotlight: "Larger Hospital Systems Loom in New Jersey's Future, New Report Forecasts" - with interactive maps and data sets
Collen O'Dea wrote in NJSpotlight: "Mapping the Location of New Jersey's Urgent Care and Retail Clinics" - with interactive maps and data sets
Lisa Ward wrote in Crain's New York Business: "New York hospitals cast an acquisitive eye toward New Jersey; Wave of mergers shifts market across the Hudson."
State Market Reports for 2015:
Colorado Health Market Review 2015 released October 13. "Colorado hospitals consolidate and post strong profits; Health insurers add new members but profits fall"
- David Olinger @dolingerdp wrote in the Denver Post: "Colorado hospitals make more money despite lower bed occupancy rates"
- Ed Sealover @esealoverdenverbiz wrote in the Denver Business Journal: "Denver-area hospitals earn record profit margins"
Michigan Health Market Review 2015, Part One, released August 12: "HMO Enrollment Grows Sharply; Medicaid HMOs Add Members and Improve Profits."
- Karen Bouffard wrote in the Detroit News: "Enrollment up in Michigan Medicaid HMOs, individual plans
- Jay Greene @jaybgreene wrote in Crain's Detroit Business: "Operating income of Michigan Medicaid HMOs rises 295% in 2014"
Minnesota Health Market Review 2015, Part One, released July 1: "Almost 220,000 Medicaid Enrollees Join HMOs, While Volatile Individual Market Adds and Rearranges Enrollees; Profitable Medicare and Medicaid Plans Boost HMO Reserves Even More."
Christopher Snowbeck wrote in the Minneapolis StarTribune: "Government programs drove insurer earnings"
Katherine Grayson wrote in the Minneapolis St Paul Business Journal: "PreferredOne shed 70,000 individual plan members, analyst says
If you skipped 2014 reports for Michigan, Minnesota or Texas, you can order both 2015 and 2014 reports for those states for $225 (2014/2013 for Texas). Click here to order.
Minnesota Health Market Review 2014, Part Two, released May 15: "Minnesota Health Systems Are Strongly Profitable Again; Health Plans Add 238,000 New Members"
- Nick Woltman wrote in the St. Paul Pioneer Press: "Twin Cities hospitals' profits continue to rise, report says"
- Christopher Snowbeck wrote in the StarTribune: "Net income rises at Twin Cities hospitals in 2013, report says"
Michigan Health Market Review 2014, Part Two, released March 9, 2015: "Detroit-Area Hospitals See Declining Inpatient Days, Revenues and Net Income in 2013; Health Plan Enrollment Grows Sharply, But Profits Are Smaller in 2014"
- Karen Bouffard wrote in The Detroit News: "Revenues for Metro Detroit hospitals declined in 2013" Click here to view.
- Jay Greene wrote in Crain's Detroit Business: "Survey: Detroit hospital profits, patient volume down; elsewhere in state, hospital income up" Click here to view
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."
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.
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.
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.
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"
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.
Reports and data sets now available for these states:
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:
We hope you will visit this site frequently. We will regularly add information about new reports as they are released. In addition, our Industry News section will put breaking news into the context that you need. Please contact us if you have questions or comments. To reach us send E-mail to: Baumg010@tc.umn.edu
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