National health reform initiatives will be implemented in local markets, creating opportunities and challenges. Markets are different - in how providers organize and practice and in how health plans compete.
Some states are moving at full speed to expand Medicaid eligibility and to build out their health insurance exchange, while others are doing as little as possible.
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 governments 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. Did a reinvigorated Detroit Medical Center, now owned by Vanguard, drive an announced merger of the Henry Ford and Beaumont systems? Why did that merger collapse and what does the future hold for those systems? 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.
- Medicaid is now the largest line of business for HMOs in many states and they should enjoy significant, profitable growth in states that are expanding eligibility under the ACA, effective January 1, 2014. But are their profits too high? The Minneapolis StarTribune cites my research on payments and profits for Medicaid HMOs in Minnesota, Michigan and Wisconsin in an editorial entitled: "Is State Overpaying Health Plans?" In his blog at Forbes.com, Michael Millenson summarizes my 2011 Texas report: "Big Government Brings Big Profits to Texas Health Plans." Minnesota introduced competitive bidding and a 1% cap on HMO Medicaid profits - after HMOs had average margins of 8.9%.
- 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
Our On-Line Store Is Now Open For Your Business! 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"
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"
Texas Health Market Review 2013 released October 9: "Texas HMOs enjoy strong profitability and enrollment growth; Inpatient hospital utilization declines as new hospitals go up"
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"
Michigan Health Market Review 2013, Part One, was released July 18: "Health insurers repeat strong profitability; Face uncertainty as well as good prospects for growth." Part Two report, focusing on hospital systems, to be released February 24.
Minnesota Health Market Review 2013, Part One, was released July 15: "Minnesota HMOs Report Strong Profits, Large Reserves." Part Two report, focusing on providers, to be released March 10.
If you skipped 2012 reports for Michigan or Minnesota, you can order both 2012 and 2013 reports for those states for $225. Click here to order.
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"
Wisconsin Health Market Review 2012 released February 4, 2013: "Implementation of Health Reform Creates New Opportunities and Challenges; Hospital Maintain Profitability Even as Utilization Declines"
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:
Third update of New York United Hospital Fund annual health insurance market study released August 20: "2010 Was a Positive Year for New York's Health Plans." Report examines impact of Affordable Care Act on insurance markets
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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