BURLINGTON, Mass., May 8, 2014 /PRNewswire/ -- Decision Resources Group's projections of 2014 exchange enrollment reveal great regional diversity in U.S. health insurance markets. State Exchanges, which opened for enrollment October 1, 2013, are both state- and federally-run. Many variables determine which plans will come out on top, but looking at the past experience and relative pricing of plans participating in the exchanges is instructive. For instance, Blue plans will likely be among the leaders in the states where they are dominant and able to leverage that clout into narrow-network plans with a price advantage over competitors.

Key Facts:

  • Consumer-operated and -oriented plans will have a significant impact in the Northeast.
  • In the Midwest, carriers with a track record of managing care for Medicaid beneficiaries are projected to do well in Ohio (Centene's Ambetter from Buckeye Community Health Plan).
  • Western states have the highest concentration of state-run exchanges and will likely have higher than average enrollment.
  • Other than Florida and Virginia, competition is lacking in Southeastern states.
  • Health Care Service Corporation will be a force to be reckoned with throughout the Southwest.
  • A just-released pdf download, "Exchange Profiles: A Regional Look," elaborates on these findings.
  • Decision Resources Group's projection model uses proprietary enrollment data, brand recognition metrics and pricing.


  • Dave Raiford, Senior Director for Decision Resources Group, said: "A regional look at projected exchange enrollment shows the diversity of the U.S. health insurance market. Given the Northeast's population concentration and large integrated health systems, exchange plans tied to large provider networks are projected to do very well in gaining market share. And uniquely, the Southeast is projected to have a heavy presence of national carriers in exchanges throughout the region."
  • Mark Cherry, Senior Analyst for Decision Resources Group, adds: "The exchanges were designed for individual customers instead of large multistate groups, so the top exchange performers reflect regional variances. Blues plans are a good example--because of their local knowledge and leverage, Blues plans in most states were especially well positioned to succeed on the exchange.  These regional nuances will also be an integral part of 2015 planning for businesses with interests across U.S. managed care."

Additional Resources:

  • Decision Resources Group has created a "State Exchange Report Card", which evaluates each state's exchange on a variety of criteria, including readiness, competition and potential to impact their markets. Download the latest "Report Card" at www.hl-isy.com/State-Exchange-Report-Card

About Health Plan Data & Analysis

NEW: The "Exchange Profile" report series, which includes state-specific enrollment projections, is now part of Health Plan Data & Analysis.

Health Plan Data & Analysis is the tool for understanding the competitive managed care organization landscape, providing state health plan information that drives meeting preparation, strategic planning, and sales strategy development. It provides event-driven insights into the latest state health plan trends that drive local-level sales and planning strategy development and includes updates on:

  • Commercial Carriers
  • Managed Medicare Markets
  • Managed Medicaid Markets
  • Pharmacy Benefits
  • Patient Care Management
  • Legislation
  • Healthcare Reform
  • Key Market Events

About Decision Resources Group

Decision Resources Group offers best-in-class, high-value information and insights on critical issues within the healthcare industry. DRG insights and analysis on the U.S. managed care market are powered by HealthLeaders-InterStudy. Clients rely on this analysis and data to make informed decisions. Find out more at www.hl-isy.com and www.DecisionResourcesGroup.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

For more information, contact:

Christopher Comfort
Decision Resources Group

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SOURCE Decision Resources Group

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