According to the most recent edition of The Competitive Edge Regional Market Analysis, released by InterStudy Publications, total HMO enrollment--90% of which is located within metropolitan statistical areas (MSAs)-- dropped by more than 3.5 million in the last year. The report finds that this occurrence is part of a national trend of declining HMO enrollment.
The Regional Market Analysis 13.1 provides a comprehensive look at the 329 MSAs across the United States with active HMOs as of July 1, 2002. For each MSA, the report provides detailed information on HMO enrollment and market penetration. The report contains five subdirectories of MSA data: metropolitan markets, market structure, physicians, hospitals, and population statistics. The report also includes benchmarks of HMO activity that can be used to compare MSAs nationwide.
InterStudy developed an innovative new method for examining uninsured rates that provides a more accurate reflection of the market at the MSA level. In the past, estimates of uninsured lives were the same for every MSA in a state because the Census Bureau only provides uninsured data at the state level. InterStudy's new method examines uninsured populations by adjusting for demographic indicators that impact the likelihood of being uninsured.
"This new method provides more accurate uninsured estimates at the MSA level, which further impacts the analysis of the rest of the health care market," said Tammy Lauer, director of research for InterStudy Publications.
Physician and Hospital Reimbursement
The Regional Market Analysis 13.1 provides estimates for individual MSAs of the percentages of hospital services, primary care physician services, and specialty care physician services reimbursed through various methods. The report also provides reimbursement benchmarks for all metropolitan markets and includes information on general HMO reimbursement trends.
"Trends in physician and hospital reimbursement in MSAs reflect the national trends, meaning that, overall, the use of capitation as a reimbursement method is declining, while fee-for-service reimbursement is increasing," said Lauer. "This trend illustrates a shift in the influence of physicians in the marketplace. Providers in many parts of the country have been successful in banding together to negotiate more favorable reimbursement terms."
About Competitive Edge
InterStudy publishes the InterStudy Competitive Edge series semi-annually. The Regional Market Analysis 13.1 is the third in a three-part series on HMOs, and examines market structure and dynamics of metropolitan markets served by HMOs. The HMO Directory is the first report in the series, and Part II, The HMO Industry Report, analyses plan growth and characteristics associated with growth in HMOs.
About InterStudy Publications
InterStudy Publications, a division of Decision Resources, Inc., offers data, directories, and analyses of the ever-evolving managed care industry. InterStudy tracks changes and trends in HMO and PPO services, enrollment, and profitability. Visit InterStudy Publications at www.interstudypublications.com.
About Decision Resources
Decision Resources is a world leader in research publications, advisory services, and consulting designed to help clients shape strategy, allocate resources, and master their chosen markets. The company provides strategic information services, and assesses international pharmaceutical and health care industry trends. Visit Decision Resources at www.DecisionResources.com.
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SOURCE: Decision Resources
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