Allan Baumgarten Health Market Reviews & Consulting
The COVID-19 pandemic has underlined the importance of states in setting health policy, whether in responding to the pandemic or deciding how to implement the coverage expansion initiatives of the Affordable Care Act. Some embraced the extension of Medicaid eligibility and built their own health insurance exchanges. Others have rejected the opportunity to bring coverage to low-income households and billions of federal dollars to their safety net providers. Medicaid enrollment in several expansion states has grown by 10 to 15% in 2020 and 2021, as people lost jobs and sought other kinds of coverage. And despite the large numbers of COVID-19 patients, health insurers saw much lower claims and improved profits in 2020. Data for the first nine months of 2021 suggest a return to higher levels of claims and somewhat lower profitability.
Our annual market reports and data sets are an invaluable source of insight into several state health care markets. We assemble data on health plans and provider systems and weave that analysis together with the perspectives of leaders in each market. By touring our web site, you can download samples of what is in those reports and data sets.
Through our consulting research, we apply our analysis of local markets to help pharmaceutical companies, health plans, provider organizations, health purchasers, investment firms and government agencies to address the business competition and strategy issues that they face. Below we describe some of the research we have recently completed for clients like the Robert Wood Johnson Foundation.
- Medicaid is now the largest line of business for HMOs in many states and they enjoyed significant, profitable growth in states that expanded eligibility under the ACA. These contracts represent a huge business opportunity for managed care companies, with states evaluating competitive bids for multi-year contracts worth billions in revenues. In September 2020, the Robert Wood Johnson Foundation released my research on how states contract with Medicaid managed care companies and oversee performance under those contracts. The report and a multi-year data set with financial and enrollment data on those companies is available here. That research was featured in a Tradeoffs podcast: “Has Medicaid Managed Care Delivered on its Promise?” Click here to listen. A follow-up blog posting in Health Affairs examined how some states are looking to their Medicaid managed care contracts to help address state revenue shortfalls. A related piece published by the Altarum Healthcare Value Hub examined the results in states like Oregon, Colorado and Minnesota that are contracting with provider organizations for Medicaid. That paper, “Going Beyond Traditional Medicaid Managed Care Contracting,” can be downloaded here.
- Competitive pressures plus changes in Medicare payment are driving more consolidation for both hospitals and health plans. Companies like Centene and Molina have completed a series of acquisitions of regional Medicaid plans. The entry of two for-profit companies, Vanguard Health, now part of Tenet, and Prime Healthcare in the Detroit market has resulted in more vigorous competition for a shrinking pie of hospital care. See my data and comments in HealthLeaders and in the Detroit News. While a number of hospital M&A deals have been completed in recent years, others have been cancelled. In the last year, Beaumont Health in Detroit, itself the result of a large merger, called off a planned acquisition of Summa Health in Ohio and then proposed and cancelled a merger with the Advocate Aurora system of Illinois and Wisconsin. In June 2021 it announced that it would merge with Spectrum Health in west Michigan, owner of the Priority Health insurance companies, and that merger was completed in early 2022, without being challenged by antitrust regulators.
- Some systems are pursuing other strategies for extending their geographic reach, in some cases going beyond traditional local market boundaries. In 2017, the Robert Wood Johnson Foundation released my report analyzing the new generation of provider-sponsored health plans. A follow-up blog posting in Health Affairs focuses on the joint venture strategy used by most of the recent health plan start-ups. RWJF also supported a 2015 study of hospital consolidation and strategic partnerships for provider systems in New Jersey. My New Jersey report describes how MD Anderson Cancer Center is taking these national networks to a new, higher level by opening an M.D. Anderson satellite at Cooper University Medical Center in Camden, NJ and its fourth center at Baptist Hospital in Jacksonville, FL. Memorial Sloan Kettering is also building a network of cancer centers, most recently in Miami, in partnership with the Baptist Health system there.
- New coverage options through state exchanges are transforming the individual insurance markets in different states, as new competitors arrives and insurers compete on price and networks. In Florida, for example, enrollment in HMO individual plans grew by 900,000 in 18 months and continues to grow. While early losses and uncertainty about subsidies for consumer cost-sharing led some insurers to drop out of that market, several states took steps to stabilize their markets and new entrants are now completing in many states.
- Strong profits but risks for hospitals with their ambitious construction projects, seeking to expand their market share and extend their geographic reach. Lauren Silverman’s report for NPR describes how billions are being spent on hospital construction in north Texas and quotes me: “If I were a contractor, I would wake up every morning and thank G-d for the health care business.” Still, some systems were making plans to downsize their inpatient footprint before the pandemic, while others, having suffered large operating losses in 2020, are cutting staff and closing hospitals and clinic locations to stop the financial bleeding.
New State Market Reports for 2021 and 2020
Michigan Health Market Review 2021, Part Two, released May 4, 2022: “Revenues and inpatient days dropped sharply for Detroit-area hospitals, but they were still profitable; Health insurers added members in 2021 but saw higher medical claims and lower profits”
- Robin Erb wrote in Bridge Michigan: “Beaumont-Spectrum merger: history says higher costs, not better care.” Click here to read.
- Tara Bannow and Bob Herman wrote in STAT: “Omicron squeezed hospitals more than health insurers in the first quarter.” Click here to read.
Minnesota Health Market Review 2021, Part Two, released March 30: “In first year of pandemic, hospitals report fewer inpatient days, mixed financial results;HMOs increase enrollment and see higher medical expenses in 2021.”
Florida Health Market Review 2021 was released March 2: “COVID-10 pandemic drives higher enrollment and profits for health insurers; Federal funds help Florida hospital systems to maintain profitability.”
- Katrine Bruner reported for Health News Florida/WUSF Public Media: “Florida’s hospital systems remained profitable in 2020 despite pandemic, report says.” Click here to listen or read.
- Ryan Lynch cited the new report in the Orlando Business Journal: “AdventHealth, Philadelphia orthopedic group partner on more expansion.” Click here to read.
- Caroline Catherman cited the new report in the Orlando Sentinel: “Central Florida can expect more hospitals, services in 2022 as region grows.” Click here to read:
- Cindy Kirschner Goodman wrote in the Sun-Sentinel: “Baptist Health wants to open its first hospital in Broward. But Broward Health and Memorial offer a dueling hospital.” Click here to read about hospital growth strategies.
Colorado Health Market Review 2021 released January 5, 2022: “Colorado health insurers increase enrollment and post record profits; Hospitals profits decline in 2019 and 2020 but remain strong.”
• John Ingold wrote in the Colorado Sun: “Thanks in part to federal relief funds, most Colorado hospitals were profitable in 2020.” Click here to read
Michigan Health Market Review 2021, Part One, released July 30, 2021: “Confounding gloomy predictions, Michigan HMOs post record profits and increase enrollment in the year of COVID-19”
- Karen Bouffard and Breana Noble wrote in the Detroit News: “Beaumont-Spectrum tie-up faces hurdles as mega-merger’s impact weighed” Click here to read.
- Jay Greene wrote in Crain’s Detroit Business: “Report: Michigan health insurers post big margin gains in first nine months of 2020.” Click here to read
Minnesota Health Market Review 2021, Part One, released June 17: “COVID-19 pandemic drives higher profits for health plans, increases in Medicaid managed care enrollment.”
- Christopher Snowbeck wrote in the Minneapolis StarTribune: “Allina-Aetna says its enrollment hits 12,000” Click here to view
- Paul James Scott wrote in the Rochester Post-Bulletin
If you missed the 2020 reports, you can get special pricing on the 2021 and 2020 reports. Click here to shop.
Texas Health Market Review 2020 released March 9: “Texas Health Insurers Reap Strong Profits in First Nine Months of 2020; Hospitals Continue Consolidation and Profitability”
- Data from the report on hospitals and health plans appears in the weekly Economic Snapshot, “Obamacare’s Impacts,” in the Dallas Morning News
Minnesota Health Market Review 2020, Part Two, released January 6: “Health insurers report 16.5% more Medicaid enrollees, reduced claims and stronger profits in 2020; Minnesota hospitals posted continued strong net income in 2019.”
Ohio Health Market Review 2020 released November 20: “Health insurers profit from reduced utilization and claims; Hospital profitability grows in three largest metropolitan areas”
- Kaitlin Schroeder wrote in the Dayton Daily News: “CareSource sees uptick in Ohio Medicaid enrollment.” Click here to read
- Lydia Coutre wrote in Crains Cleveland Business: “Insuring a new market: Cleveland Clinic sets sights on employers with Aetna partnership.” Click here to read.
- Government Financial Officers Association annual conference in St. Louis, May 7. Speaking at session “Behind the Curtain: Price Transparency in Health Care.” Click here for more information
- Medicare Advantage Summit in Washington, DC, on May 17: Speaking at mini-summit: “Provider-Sponsored and Plan-Provider Joint Venture Medicare Advantage Plans.” Click here for more information
- Minnesota Health Action Group Member Meeting, June 21. Speaking on “The Changing Landscape for Health Care In Minnesota: Data and Insights for Employers.” Click here for more information
- I spoke Friday, January 20, to the monthly breakfast meeting of the Minnesota State Bar Association Health Law Section, hosted at the Mitchell Hamline School of Law Health Institute in St Paul. The topic: “Trends and Strategies for Minnesota Health Plans and Providers.” Click here to view the presentation slides
- I presented on July 28, 2017 to the Minnesota Medical Group Management Association Summer Conference in Breezy Point. Click here to view the presentation slides
- September 13, 2017: Presented for Minnesota Community Measurement Annual Seminar. Click here for information on MNCM. Click here to view the presentation slides
New Analysis of New Provider-Sponsored Health Plans
“Analysis of Integrated Delivery Systems and Provider-Sponsored Health Plans” published by the Robert Wood Johnson Foundation, June 2017. “Thirty-seven provider-sponsored health plans have formed since 2010 and only four were profitable in 2015.” Click here for a summary and to download the report and special data sets on more than 100 provider-sponsored health plans, old and new.
Analysis of Provider System Strategies in New Jersey
“Recent Changes in Primary Care Delivery and Health Provider Systems in New Jersey” published by the Robert Wood Johnson Foundation, June 2015. “The trend toward consolidation of providers is likely to continue and the importance of the strategic alliances is likely to grow.” Click here for a summary and to download the report and special data sets on hospitals and convenient care clinics in the state. Local coverage:
Andrew @Kitchenman wrote in NJSpotlight: “Larger Hospital Systems Loom in New Jersey’s Future, New Report Forecasts” – with interactive maps and data sets
Collen O’Dea wrote in NJSpotlight: “Mapping the Location of New Jersey’s Urgent Care and Retail Clinics” – with interactive maps and data sets
Lisa Ward wrote in Crain’s New York Business: “New York hospitals cast an acquisitive eye toward New Jersey; Wave of mergers shifts market across the Hudson.”
Reports and data sets now available for these states:
Want to see a sample market study? Several reports are available for free PDF download. Follow the links for:
- The Big Picture: Private and Public Health Insurance Markets in New York, by Peter Newell and Allan Baumgarten
- The Big Picture IV: New York’s Private and Public Insurance Markets, 2010, and the Affordable Care Act, released August 2012
- Arizona Health Care Market Report
- California Health Care Market Report
- Kentucky Health Care Market Report
We hope you will visit this site frequently. We will regularly add information about new reports as they are released. In addition, our Industry News section will put breaking news into the context that you need. Please contact us if you have questions or comments. To reach us send E-mail to: Baumg010@umn.edu
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