The Des Moines healthcare market is largely defined by its two leading health systems, UnityPoint and MercyOne, which dominate the area through their wide networks, employed or affiliated physicians, and relationships with regional payers. UnityPoint holds more than half of the market’s inpatient discharges and basically splits the market with rival MercyOne. MercyOne has seen its ability to compete begin to diminish, as UnityPoint is simply too large, integrated, and well-funded. The Des Moines market continues to struggle to attract and retain providers, and most of the physicians in the market are controlled to some extent by one of the market’s large health systems. The state’s managed Medicaid program, IA Health Link, shook up the managed Medicaid sector in the state when it swapped out sector-leading UnitedHealthcare for Centene subsidiary Iowa Total Care, redistributing Medicaid enrollment.

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