Page 42 - 2013 Hospitals/Systems Digest US.NMH.13.02.007
Basic HTML Version
42
HOSPI TALS IN INTEGRATED SYSTEMS
HOSPITALS/SYSTEMS DIGEST 2013
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
DEMOGRAPHICS
HMOs With System Affiliation Tend to Have Larger Memberships
• In 2011, system-affiliated HMOs were more
likely to enroll 250,000 or more members than
their nonsystem peers: 27.0% vs. 19.6%. Overall,
20.8% of HMOs had at least 250,000 members.
• Meanwhile, 22.0% of nonsystem HMOs enrolled
fewer than 25,000 members, up from 21.4%
the prior year. Less than 10% of HMOs tied
to systems belonged in this size category.
Data source: IMS Health © 2013
HMO Enrollment, by system affiliation
1
HMOs in Highly Integrated Systems Enroll a Growing Share of Overall HMO Membership
• HMOs affiliated with highly integrated systems
accounted for just 16.7% of all HMOs in 2011, but
enrolled a disproportionate 25.1% of all HMO
members that year (up from 23.9% in 2010).
• After a near 20% boost in Medicare enrollment
between 2010 and 2011 (data not shown),
system-affiliated plans grew enrollment by 8.2%,
compared with 1.3% for nonaffiliated HMOs.
HMOs affiliated with highly integrated systems, 2011
1
HMOs in Systems
HMOs Not in Systems
ALL HMOs
HMO model type
Number
Percentage Number
Percentage Number
Percentage
IPA
24
32.4%
183
49.7%
207
46.8%
Network
24
32.4
158
42.9
182
41.2
Group
20
27.0
19
5.2
39
8.8
Staff
6
8.1
8
2.2
14
3.2
HMO membership size
<15,000
3
4.1%
45
12.2%
48
10.9%
15,000–24,999
4
5.4
36
9.8
40
9.0
25,000–49,999
12
16.2
50
13.6
62
14.0
50,000–99,999
16
21.6
78
21.2
94
21.3
100,000–249,999
19
25.7
87
23.6
106
24.0
250,000+
20
27.0
72
19.6
92
20.8
HMO tax status
Not-for-Profit
47
63.5%
101
27.4%
148
33.5%
For-Profit
27
36.5
267
72.6
294
66.5
Total
74
100.0%
368
100.0%
442
100.0%
1
HMOs are considered to be in highly integrated health systems if they are part of a system by virtue of ownership or contractual arrangements.
HMOs are not considered to be in integrated health systems if they hold only provider network contracts with systems. All data are as of calendar
year 2011. Preoperational HMOs are excluded.
2
See page 5 of the HMO-PPO
Rx
Digest for 2012–2013.
Key Takeaway
Compared with their nonsystem counterparts, HMOs tied to highly integrated systems seemed
better positioned to capitalize on the enrollment growth experienced in recent years by HMOs
nationally.
2
Although the total number of system-tied HMOs increased slightly in 2011 (to 74 from
72 the prior year), such HMOs still represented a small but slowly growing minority.
0
20
40
60
80
Enrollment (in Millions)
HMOs in Systems
HMOs Not in Systems
All HMOs
18.4
19.9
58.8
59.6
77.2
79.5
2010
2011
