National Statistics

 

National Managed Care Enrollment 2009

HMO (1) 64.5 million
PPO 61.9 million
Total (1) 126.4 million

 

Managed Care Penetration

(#'s in millions)
Segment
Total
U.S.
Percent
U.S.
Managed
Care #
Managed
Care %
Medicare (2)(3) 45.0 14.7% 10.4 23.1%
Medicaid (4) (5) 42.1 13.8% 28.5 67.7%
Commercial 154.1 50.5% 115.0 74.6%
Uninsured (6) 48.0 15.7% 0.0 0.00%
TOTAL (7) 306.0 100.0% 153.9 50.3%

 

Key HMO Performance Measures

  Commercial

Medicare

Hospital Inpatient Days Per 1,000 Per Member (8)

224

1,497
Physician Encounters Per Member Per Year (8)

3.8

8.9
Rx's Utilization Per Member Per Year (8)

9.0

25.6

Plan Medical Loss Ratio (9)

81.0%

Average PMPM Rates - Physician (10)

$61.69

$263.58

Average PMPM Rates - Hospital (10) $63.73 N/A

 

 

2009 Premium Rate/Cost Increase Projections by Product (11)
  Towers Aon* Hewitt Segal*
HMO 7.0% 10.8% 8.0% 10.0%
PPO 6.0% 10.9% 5.5% 10.6%
POS 8.0% 10.5% 5.5% 10.6%
High Deductible N/A 10.3% N/A 10.8%
Rx N/A 9.5% N/A 10.7%
OVERALL 6.0% N/A 6.4% N/A
*without Rx
Data supplied by MCOL E-Commerce and Member web site content partners.
 
(1) HealthLeaders-InterStudy, data as of January 2008.  Total Managed Care Plans data reported in HealthLeaders-InterStudy press release dated September 15, 2008. HMO Enrollment data as of July 2008 as published on Kaiser Family Foundation's State Health Facts web site (www.statehealthfacts.org) via HealthLeaders, special data request, March 2009.
 
(2) Centers for Medicare and Medicaid Services (CMS), data as of January 1, 2009. www.cms.gov
 
(3) Medicare Advantage Fact Sheet, The Kaiser Family Foundation, January 2009. www.kff.org.
 
(4) Medicaid Enrollment Notes: Data are "point-in-time" monthly enrollment counts. Data as of December 2006, published January 2008. Sources: Compiled by the Health Management Associates from state Medicaid enrollment reports, for the Kaiser Commission on Medicaid and the Uninsured. "Medicaid Enrollment in 50 States: December 2006 Update" available at http://www.kff.org/medicaid/7606.cfm. Publication: KFF's State Health Facts.org web site at: http://www.statehealthfacts.org/comparemaptable.jsp?ind=201&cat=4
 
(5) Medicaid Managed Care Enrollment Data Notes: Data as of June 30, 2007. The data shown here are unduplicated figures that include enrollees receiving comprehensive and limited benefits. Individuals enrolled only in Primary Care Case Management programs (PCCM) are counted here. For more details, please see the Enrollment by Medicaid MC Plan Type topic. Figures also include individuals enrolled in state health care reform programs that expand eligibility beyond traditional Medicaid eligibility standards. Sources: Medicaid Managed Care Penetration Rates by State as of June 30, 2007, Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services, special data request, August, 2008. Publication: KFF's State Health Facts.org web site at: http://www.statehealthfacts.org/comparemaptable.jsp?ind=216&cat=4
 
(6) The Path to a High Performance U.S. Health System: A 2020 Vision and the Policies to pace the Way. February 2009. The Commonwealth Fund. Data as of June 2006, published January 2009.
 
(7) Total U.S. Population data as of March 9, 2009, U.S. Census Bureau. www.census.gov.
 
(8) eHMO-PPO Digest for 2008. Data as of 2007. Sanofi Aventis. www.managedcaredigest.com
 
(9) Sherlock Company PULSE, March 2008. Sherlock Company. Data for all publicly-traded health plans. Used with permission.
 
(10) 2008 Capitation Survey. 2005 Data. Reprinted with permission from HCPro, Inc. Marblehead, MA.  Please visit http://www.hcmarketplace.com/prod-5957.html for more information.
 
(11) Compilation from survey data files available in MCOL member web site

 

 


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