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Managed Care Industry in the United States: Healthy and Hungry for Continued Growth
Decision Resources, Inc., Dec 2007, Pages: 24
Introduction
With commercial enrollment stalled, the managed care industry is looking for creative ways to grow business. Five years of profits have given health insurers the wherewithal to make deals and invest in new ventures. Mergers and acquisitions, joint ventures, and even emerging international markets such as China offer tremendous opportunities to the managed care industry as it blazes new trails in the quest for continued growth. This report, based in part on interviews with industry insiders, tracks select efforts and ambitions of the industry.
Get the Answers You Need to Shape Your Strategy
- M&A activity among managed care organizations (MCOs) declined in 2006 but began ramping up in 2007 as profitable plans seek ways to grow revenue. What are the drivers of this surge in M&A activity among MCOs? How are regional health plans shaping this national trend? What profi table opportunities can insurance-market players find in partnerships with the government as Medicare and Medicaid expand? What are the implications of increased MCO consolidation for employers and the pharmaceutical industry?
- Taking a page from the playbook of their national competitors that have become one-stop shops for health care services, Blue Cross Blue Shield companies are developing joint ventures to become as integrated as forprofit plans. What activities are fueling the growth and integration of Blue-owned companies? How are the Blue plans increasing their stake in the consumer-driven health plan market segment?
- Rapidly growing middle-class populations in many countries are presenting significant opportunities to U.S.- based health insurers. Which insurance-market players are entering emerging markets? What are the potential barriers to success in such an endeavor?
Scope
- Merger & acquisition activity in the managed care arena: Medicare Part D, Medicaid, provider-owned plans, marketing partnerships, small regional health plan expansions, and federal/state partnerships all have an impact on consolidation activities in the managed care market.
- Blue plans break ground: Blue Cross Blue Shield establishes a bank; its pharmacy benefits management company continues to grow; and it is building what will be the largest database of health claims information in the United States.
- U.S. insurers forge partnerships in risky markets: insurance-market players investigate global opportunities in emerging markets such as China and India.
Mentioned in This Report: Key Concepts
- ABD
- Carve outs
- China
- Chronic care
- Consolidation
- Consumer-driven coverage
- Cost containment
- Formulary management
- Global ventures
- Health claims database
- Health maintenance organization
- Health savings account
- India
- Managed care
- Massachusetts Connector
- Medicaid
- Medicare Part D
- Mergers & acquisitions
- Partnerships
- Pharmacy benefit management
- Preferred provider organization
- Specialty plans
- Uninsured population
- Universal health insurance coverage
- Venture capital
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