Managed Care National Statistics

Managed Care National Statistics

National Managed Care Enrollment 2008
HMO (1)	88.8 million
PPO (1)	60.1 million
Total	148.9 million

Managed Care Penetration

(#'s in millions) Segment	Total U.S.	Percent U.S.	Managed Care #	Managed Care %
Medicare (2)(3)	44.2	14.6%	8.7	20%
Medicaid (4) (5)	58.9	19.4%	38.3	65%
Commercial	152.9	50.46	101.9	66.6%
Uninsured (6)	47.0	15.5%	0.0	0.00%
TOTAL (7)	303.0	100.0%	148.9	49.1%

Key HMO Performance Measures
	Commercial	Medicare
Hospital Inpatient Days Per 1,000 Per Member (8)	224	1,529
Physician Encounters Per Member Per Year (8)	3.3	8.4
Rx's Utilization Per Member Per Year (8)	8.9	24.6
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

2008 Premium Rate/Cost Increase Projections by Product (11)

	Towers	Aon*	Hewitt	Segal*
HMO	7%	11.0%	9.0%	10.7%
PPO	6%	11.3%	8.5%	10.5%
POS	8%	10.9%	8.5%	10.6%
High Deductible	N/A	NA	N/A	10.9%
Rx	N/A	12.3%	N/A	10.7%
OVERALL	6%	N/A	8.7%	N/A

*without Rx
Data supplied by MCOL E-Commerce and Member web site content partners.
(1) Estimated by AIS based on enrollment breakdowns provided in "AIS's Directory of Health Plans: 2008." HMO estimate includes commercial HMO, POS, Medicare and Medicaid plans. Used with permission. www.aishealth.com/Products/dhp.html
(2) Centers for Medicare and Medicaid Services (CMS), data as of January 1, 2008. www.cms.gov
(3) Medicare Advantage Fact Sheet, The Kaiser Family Foundation, June 2007. www.kff.org.
(4) Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on data from Medicaid Statistical Information System (MSIS) reports from the Centers for Medicare and Medicaid Services (CMS), 2008. Data as of FY 2005.
(5) Medicaid Managed Care percentage data as of June 30, 2006. Medicaid Managed Care Penetration Rates by State as of June 30, 2006. Centers for Medicare and Medicaid Services, retrieved June 2007. Available at http://www.cms.hhs.gov/MedicaidDataSourcesGenInfo/Downloads/mmcer06.pdf
(6) Health Insurance Coverage: 2006, U.S. Census Bureau.
(7) Total U.S. Population data as of February 7, 2008, U.S. Census Bureau
(8) eHMO-PPO Digest for 2007. Data as of 2006. Sanofi Aventis.
(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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