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National Statistics

 

National Managed Care Enrollment 2010

Health Maintenance Organization (HMO) 66.21 million
Preferred Provider Organization (PPO) 53.20 million
Point of Service (POS) 8.87 million
High Deductible Health Plan (HDHP) 7.09 million
Total (1) 135.37 million

 

Managed Care Penetration

(#'s in millions)
Segment
Total
U.S.
Percent
U.S.
Managed
Care #
Managed
Care %
Medicare (2) 47.0 15.21% 11.40 24.2%
Medicaid (3) 46.87 15.17% 33.28 71.0%
Military (3) 3.8 1.20 3.8 100.0%
Commercial 161.93 52.40% 86.89 53.65%
Uninsured (4) 49.4 16.0% 0.0 0.00%
TOTAL (5) 309.0 100.0% 135.37 43.80%

 

 

Key HMO Performance Measures

  Non-Medicare

Medicare

Hospital Inpatient Days Per 1,000 Per Member (6)

224

1,502
Physician Encounters Per Member Per Year (6)

4.0

9.1
Rx's Utilization Per Member Per Year (6)

9.2

27.2

Plan Medical Loss Ratio (7)

83.1%

Average PMPM Rates - Physician (8)

$61.69

$263.58

Average PMPM Rates - Hospital (8) $63.73 N/A

 

 

2010 Premium Rate/Cost Increase Projections by Product (9)
  Buck Consultants Aon* Hewitt Segal*
HMO 10.3% 10.6% 8.0% 10.0%
PPO 11.1% 11.0% 5.5% 10.6%
POS 10.9% 10.6% 5.0% 10.6%
High Deductible/Consumer Driven Health Plans 10.3% 10.6% N/A 11.9%
Rx 10.9% 9.4% N/A 9.1%
OVERALL 10.0% N/A 6.0% 10.8%
*without Rx
 
(1) MCOL Research based upon: U.S. Department of Labor report: National Compensation Survey: Employee Benefits in the United States, March 2009. Table 9. Published September 2009. http://www.bls.gov/ncs/ebs/benefits/2009/ebbl0044.pdf and data supplied in The Kaiser Family Foundation and Health Research & Educational Trust: Employer Health Benefits 2009 Annual Survey. Exhibit 5.1. www.kff.org.
 
(2) The Kaiser Family Foundation: Medicare: A Primer. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf
 
(3) Kaiser Commission on Medicaid and the Uninsured. Medicaid and Managed Care: Key Data, Trends and Issues. February 2010. http://www.kff.org/medicaid/upload/8046.pdf; Kaiser Commission on Medicaid and the Uninsured. Medicaid Enrollment: June 2009 Data Snapshot. http://www.kff.org/medicaid/upload/8050.pdf. US Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2008, Table C-1. September 2009. http://www.census.gov/prod/2009pubs/p60-236.pdf 
 
(4) CCover the Uninsured. Accessed on April 23, 2010. http://covertheuninsured.org/content/without-reform-family-health-care-spending-skyrocket-34-increase-2015-79-2020.
 
(5) Total U.S. Population data as of April 23, 2010, U.S. Census Bureau. www.census.gov.
 
(6) Managed Care Digest Series® 2010 sanofi-aventis U.S. LLC Data source: SDI © 2009. www.managedcaredigest.com
 
(7) Sherlock Company, PULSE, April 2010. Sherlock Company. Data for all publicly-traded health plans. Used with permission.
 
(8) 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.
 
(9) Compilation from survey data files available in MCOL member web site

 

 

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