HealthLeaders-InterStudy, a leading provider of managed care industry intelligence, just released its comprehensive Managed Market County Surveyor, giving detailed, county-level information on health plan enrollment throughout the United States for 2006.
"Interestingly, our research shows that HMOs held their own in market share, at 25 percent of the insurance market," said Jane DuBose, Associate Director of Health Plan Analysis. "So even though the popularity of HMOs decreased dramatically over the past decade, there are still a sizeable number of employers who feel they get more bang for their buck with HMOs. This report gives a detailed look at where those HMO members are -- and PPO members, too."
"HealthLeaders-InterStudy's proprietary research shows that 74 million people are in traditional HMOs for 2006," said Laura Black, Director of Research Analysis. "That compares with 67.7 million people in 2005, when traditional HMOs had a 23 percent market share."
The Managed Market Surveyor breaks down HMO and PPO enrollment to the Metropolitan Statistical Area (MSA) and county level. For instance, the New York-White Plains-Wayne MSA had HMO market penetration of 29 percent as of Jan. 1, 2006, and fully insured PPO penetration of 19 percent. Among HMOs, HIP Health Plan of New York had almost 20 percent of the HMO market with close to 664,000 lives, followed by UnitedHealthcare with 8.3 percent. The biggest fully insured PPO in the New York MSA is Group Health Incorporated, with more than a million lives and 46 percent market share.
In contrast, the Chicago-Naperville-Joliet MSA had just 18.9 percent HMO penetration, with fully insured PPO penetration of 16 percent. The top dog by far in all health plan lives is Health Care Service Corp., which owns Blue Cross and Blue Shield of Illinois, a giant with 3.5 million health plan members in that state.
HMO penetration is even smaller in the Seattle-Bellevue-Everett MSA at 12.3 percent, but fully insured PPOs have 25.4 percent of the market. The fast-growing Medicaid HMO Molina Healthcare Inc. has 95,869 members in that market, or almost 32 percent of all HMO lives.
But the HMO/PPO designations mean less and less, DuBose cautioned. "The lines continue to blur between HMOs and PPOs. Both are doing preventive care, disease management, and some HMOs have deductibles and health savings accounts."
States where HMOs have a relatively high market penetration include California (49.5 percent); Massachusetts (43.4 percent); and New York (28 percent). Those with very little HMO enrollment include Texas, with just 12.8 percent penetration, and North Carolina, with just 10.2 percent.
Health plans' biggest competitor remains the same as last year: the uninsured, at 44 million.
About the Managed Market Surveyor
The Managed Market Surveyor offers a comprehensive state, MSA, and county level description of how managed care lives in a geographical region are insured: HMO, PPO, managed Medicare, managed Medicaid, uninsured, or privately insured.
HealthLeaders-InterStudy, a company of Decision Resources, Inc. (http://www.decisionresources.com/) is the authoritative source for managed care data and analysis. For more information, please visit http://www.healthleaders-interstudy.com/.
For more information, contact: Alex Jablokow Decision Resources 781-296-2562 firstname.lastname@example.org
CONTACT: Alex Jablokow of Decision Resources, +1-781-296-2562,
Web site: http://www.decisionresources.com/