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Global Managed Health Care Services Industry

  • January 2012
  • -
  • Global Industry Analysts

The global outlook series on Managed Health Care Services provides anecdotes, market briefs, and concise summaries of research findings. The report analyzes the growth drivers and market challenges, and reviews the noteworthy strategic corporate activity of the recent past. The report also discusses various types of managed care organizations and programs. A detailed review of the United States market is provided in the report, along with brief discussions on European, Australian and Hong Kong markets among others. Also included is an indexed, easy-to-refer, fact-finder directory listing the addresses, and contact details of 262 companies worldwide.

Table Of Contents

Global Managed Health Care Services Industry



1. INDUSTRY OVERVIEW 1
Market Overview 1
Quick Facts 1
Managed Care Market Recovers from Recession 2
Factors Impacting Managed Care Market 2
Managed Care Organizations - Impediments and Drivers 2
Healthcare System in Developing Countries 3
Sustainability Helps to Strike a Balance 3
US Health Insurers Eye Overseas Markets 4

2. PRODUCT OVERVIEW 5
Managed Health Care - A Conceptual Definition 5
Benefits 5
Managed Health Care - Historical Perspective 5
Managed Care Organizations (MCOs) 6
Managed Care Services for Healthcare Providers 6
Cost Reducing Managed Care Techniques 7
Managed Care Approaches 7

3. TYPES OF MANAGED CARE 9
Types of Network-Based Managed Care Programs 9
Health Maintenance Organizations (HMOs) - An Introduction 9
Features of HMOs 9
History of Health Maintenance Organizations 10
Types of HMOs 10
Primary Care Physician (PCP) 10
Staff/Group Model HMOs 10
Fee for Service Plan (FFS) 11
Independent or Individual Practice Association (IPA) 11
Preferred Provider Organizations (PPO) 11
Point-Of-Service Plans (POS) 12
Other Managed Care Programs 12
Physician-Hospital Organizations (PHOs) 12
Different PHO Structures 13
Prescription Drug Programs 13
Dental Specialty Programs 13
Managed Care Under Indemnity Insurance Plans 13
Stop Loss Arrangements 14
Mixed or Network Model HMO 14
Exclusive Provider Organization (EPO) 14
Consumer Driven Health Plans (CDHPs) 14

4. STRATEGIC CORPORATE DEVELOPMENTS 15

5. PRODUCT/SERVICE LAUNCHES 22


A REGIONAL MARKET PERSPECTIVE 23

1. THE UNITED STATES 23
Managed Care - An Introduction 23
Cost Control through Managed Care 23
Managed Care Vs Conventional Insurance 24
Recession and Managed Care Market 24
Managed Healthcare Market - On a Recovery Mode 24
Table 1: US Current and Future Analysis for Managed
Healthcare Services Market Analyzed with Annual Revenue
Figures in US$ Billion for the Years 2010 through 2015 25
Healthcare Costs Continue to Escalate 25
Stimulus Bill Offers Aid to Healthcare Industry 26
Impact of Healthcare Reforms 27
Managed Healthcare Providers Shift Focus to Third World Countries 27
Managed Care Enrollments Improve 28
Table 2: US Managed Healthcare Market (2010): Number of
Enrollments in Million by States - California, New York,
Pennsylvania, Texas, Florida, Illinois, Ohio, Michigan,
Massachusetts, New Jersey and Others 28
Managed Healthcare Companies Adopt New Strategies to Curb Rise
in Healthcare Costs 28
Medicaid Managed Care - Major Care Delivery System 29
Table 3: Medicaid Enrollments by Plan Type (2009): Percentage
Share Breakdown of Total MCO Members for Medicaid HMOs,
PCCMs, PHPs, and HIOs 29

Table 4: US Managed Medicaid Market (2009): Leading Health
Plans Ranked by Number of Enrollments (In Thousand) 30
South Offers Potential for Medicaid Managed Care Growth 30
Table 5: Medicaid Managed Care Enrollments by State (2009):
Percentage Share Breakdown for California, New York, Texas,
Florida, Pennsylvania, Michigan, and Others 30
Rising Medicaid Costs Drive Expansion of Managed Care 31
States Encourage Shift to Managed Care 31
Medicare Managed Care - Overview 32
Table 6: % of Medicare Expenditure Allocated to Managed Care
in the US (2006-2009) 32

Table 7: US Managed Medicare Market (2009): Leading Health
Plans Ranked by Number of Medicare Enrollments (In Thousand) 32
Medicare Advantage 33
Table 8: Medicare Advantage Enrollments in the US (2011):
Percentage Share Breakdown by State for California, Florida,
New York, Pennsylvania, Ohio, and Others 33

Table 9: Medicare Advantage Enrolments in the US (2010):
Percentage Share Breakdown by Plan Type - HMO, PPO, PFFS and
Others 33

Table 10: Medicare Advantage Healthcare Plans in the US
(2010): Percentage Share Breakdown of Number of Available
Plans for HMO, PPO, PFFS and Others 33

Table 11: Medicare HMO Enrollments by Region (2009):
Percentage Share Breakdown for Pacific, Mid-Atlantic, South
Atlantic, South Central, East North Central, Mountain, West
North Central, and New England 34
Rising Cost of Healthcare for Employers 34
Employers Strategize to Reduce Costs 34
PPACA to Benefit Medicaid Enrollees 35
PPACA Reforms Drive New Collaborations 35
Challenges Impede Hospital-Physician Integration 35
Consumer-Driven Health Plans - Gaining Prominence 36
HMO Market - An Overview 36
Disease Management Programs Propel HMOs Growth 37
HMOs' Witness Rise in Rates 37
HMOs and PPOs - A Comparison 37
Table 12: Number of Operating Plans for HMOs and PPOs (2009) 38
Competitive Landscape 38
Table 13: Leading Plans in the US HMO Market (2009): Ranked
by Number of HMO Enrollments (in Thousands) for Kaiser
Foundation Health Plan Inc., AETNA Health Inc., Blue Shield
of California, Coventry Health and Life Insurance Company,
Blue Cross Blue Shield of Massachusetts, and Blue Cross and
Blue Shield of Illinois 38
Reinsurance Market - Overview 39
Dental Managed Care Market 39
Competitive Scenario 39
Hospitals Restructure as PHOs to Become ACOs 39
Pharmaceutical Industry Places Emphasis on Efficient Marketing
Strategies 40
Competition 40
Table 14: Leading Health Plans in the US Managed Healthcare
Market (2010): Number of Enrollments in Million for
UnitedHealth Group, WellPoint, Inc., Aetna Inc., Health Care
Service Corporation, CIGNA HealthCare Inc., Kaiser
Permanente, Humana Inc., Health Net Inc., Blue Cross Blue
Shield of Michigan, and Highmark Inc. 41

Table 15: Leading PPO Networks in the US (2009): Ranked by
Number of Enrollments (In Thousand) for Blue Cross Blue
Shield of Michigan, AETNA Health Inc., Blue Cross and Blue
Shield of Florida Inc., Blue Cross and Blue Shield of
Illinois, Blue Shield of California, and CIGNA HealthCare,
Inc. 42

2. JAPAN 42
Healthcare System - Overview 42

3. EUROPE 43
Healthcare Market - An Overview 43
Managed Care Market 43
Corporate Layoffs Affects Managed Care Market 43

3a. GERMANY 44
Managed Healthcare System - Overview 44
GP Model Receives Mixed Response 44

4. ASIA-PACIFIC 45

4a. AUSTRALIA 45
Australia - A Healthcare Perspective 45
Mode of Healthcare Delivery 45
Funding of Healthcare 45
Challenges Ahead - Australian Managed Healthcare 45
The Path Ahead 46

4b. HONG KONG 47
Market Overview 47
Growth Driving Factors 47
MCOs Devise Newer Strategies 47
Other Strategies 48
Market Challenges 48

4c. SINGAPORE 49
Promising Future for Managed Care 49

5. LATIN AMERICA 49


GLOBAL DIRECTORY

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