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HMOs at a Glance
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January 4, 2023

Ohio Health Market Review 2022 finds:

Ohio hospitals continue major capital investments and strong profits in 2021;

HMO Medicare and Medicaid plans add enrollees, report strong profits


      Cincinnati/Dayton/Columbus/Cleveland –In the midst of the COVID-19 pandemic, Ohio hospital systems reported strong profits in 2021 from both patient care operations and other revenues, including federal Provider Relief funds. Ohio HMOs increased their enrollment by 8% in 2021, with gains in Medicare Advantage, Medicaid and individual health plans.

      These are some of the key findings in Ohio Health Market Review 2022, Allan Baumgarten’s 16th report analyzing the health care insurance and provider markets in Ohio. The report describes key trends for health care organizations and analyzes their competitive strategies. Baumgarten is an independent analyst based in Minnesota who currently publishes market reports in Ohio (since 1997) and five other states and conducts market research for a range of clients.

      In the new report, Baumgarten finds:

      Based on an analysis of Medicare cost report data for 2021 operations, Ohio hospital systems enjoyed very strong profits in 2021. In general, the systems were profitable on their patient care operations and had significant additional revenues from investments, philanthropy and government grants, including $814.8 million in federal Provider Relief funds in 2021 and $1.957 billion in 2020. (Note that cost report data for 2022 is not available yet and while some systems continue to report strong net income, others have reported losses in 2022 because of higher labor costs and losses on investments.) In the Cincinnati Dayton area, hospitals had net income of $2.302 billion, or 17.6% of net patient revenues of $13.068 billion. The two Dayton systems, Kettering Health Network and Premier Health, were especially profitable, with margins of 19.1% and 21.5%, respectively.

      In the Cleveland-Akron region, hospitals reported combined net income of $3.119 billion or 17.9% of revenues. The Cleveland Clinic system accounted for almost 75% of total net income in the region and had a combined margin of 24.4%. In the Columbus area, hospitals had net income of $2.284 billion, or 20.5% of net patient revenues, with Nationwide Children’s accounting for one-third of that and the OhioHealth hospitals having 40%.  

      Strong population growth in the Columbus region has spurred large capital investments by the local hospital systems, especially the Ohio State University and Nationwide Children’s. Nationwide, which is spending $3.3 billion on a new inpatient tower, research buildings and specialty centers, acquired Mercy Children’s hospital in Toledo. OhioHealth acquired two hospitals at the end of 2022, bringing that system to 14 hospitals across the center of the state.

      After reporting record profits in 2020, Ohio HMOs and health insurers reported very strong results in 2021. HMOs had net income of $551.4 million, down from $619.1 million in 2020, when health care utilization and claims dropped sharply. Two HMOs, Molina Healthcare and UnitedHealthcare, accounted for half of the profits in 2021. Anthem Blue Cross Blue Shield had net income of $319.7 million in 2021, while Medical Mutual reported $108.3 million.

      Medicaid managed care is a huge and very profitable business opportunity in Ohio. In 2021, the six HMOs contracting with Ohio Medicaid had underwriting profits (not including investment income) of $607.3 million or 2.9% of revenues.

      Enrollment in Medicaid managed care plans continues to grow. In 2022, 3.3 million Ohio residents were enrolled in Medicaid, and 87% of them are in six managed care plans. Enrollment in Medicaid HMOs grew by 7.5% in 2021 and by 1.3% in the first half of 2022. Ohio is implementing new contracts for Medicaid managed care, which will link payment to performance while reducing administrative costs. CareSource remains the largest Medicaid HMO in Ohio, with 1.43 million enrollees. Its efforts to expand by winning contracts in Iowa and Oklahoma have not been successful. Buckeye Community (Centene) and UnitedHealthcare Community Plan are the next largest Medicaid plans.

      Medicare Advantage enrollment has grown steadily, and about 53% of Ohio’s 2.4 million Medicare beneficiaries are in a Medicare Advantage plans, an increase of 15.6% in two years. Anthem Blue Cross Blue Shield has the largest number of Medicare HMO enrollees, followed by UnitedHealthcare, while Aetna and Humana have the largest Medicare PPO plans in the state. Enrollment in HMO and PPO individual plans grew by 16% in the first half of 2022.

      Excerpts from Ohio Health Market Review 2022, including the “Ohio HMOs at a Glance” exhibit can be viewed at Copies of the report, published in interactive PDF format, can be ordered for $160.00 at E-mail:

HMOs at a Glance
Data Set Summary
Report Contents
Market Structure 
Health Plans
Provider Systems 
Trend Review 
Health Plan Enrollment
Individual Plans and
Medicaid Managed Care
Medicare Plans
Health Plan Net Income
Financial Results by Line of Business
Provider Payments and Administrative Expenses
Capital Adequacy for Health Plans 
Hospital Systems and Regional Submarkets
Other Major Hospitals
A Look Ahead 
Media Coverage/Presentations

Ohio Health Market Review 2018  released August 21:  "Ohio hospital report strong profits, especially in Columbus area; health insurers gain enrollees and Medicaid plans are strongly profitable"

  • Barrett Brunsman wrote in the Cincinnati Business Courier: "Income surges for Great Cincinnati hospitals." Click here to read
  • Anna Saker wrote in the Cincinnati Enquirer: "Fewer people in Cincinnati hospitals for 2016, yet revenues role 18%, study shows." Click here to read

Ohio Health Market Review 2015  released January 14:  "Consolidated hospital systems pursue expanded networks, maintain profits even with fewer inpatient days; highly profitable Medicaid enrollment surges"