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Managed Healthcare - Industry Profile
First Research, June 2008, Pages: 10
Covering over 175 industries and updated every 90 days, the First Research Industry Profiles do the heavy lifting for you - saving your sales team valuable research time, enhancing client communications and giving you the competitive edge to win more business.
Easy-to-use and up-to-date, the Industry Profiles provide you with the industry research necessary to stay on top of constant changes in select industries.
The First Research profiles help target your products and services directly to prospects. The Industry Profiles provide the information and understanding you need to engage new prospects during the sales process, deepen customer relationships and strengthen your own bottom line.
Executive Summary
Brief Excerpt from Industry Overview Chapter:
The US managed healthcare industry includes about 3,000 companies with combined annual revenue of about $350 billion. Large participants include Aetna, UnitedHealth, and Humana, and nonprofits such as Kaiser Permanente and state BlueCross BlueShield organizations. The industry has become concentrated: the 50 largest companies hold more than 60 percent of the market.
COMPETITIVE LANDSCAPE
Demand is driven by the rising costs of providing medical care. The profitability of individual companies depends on efficient operations and the ability to negotiate favorable contracts with healthcare providers. Large companies and organizations have advantages in negotiating contracts with healthcare providers. Small companies can compete successfully only by providing special coverage plans, or in small markets. The industry is highly automated: annual revenue per employee is close to $1 million.
PRODUCTS, OPERATIONS & TECHNOLOGY
The industry provides various types of health insurance plans that have built-in cost containment measures, unlike traditional indemnity plans that pay whatever costs are incurred. Among the major products are HMOs; preferred provider organizations (PPO); point-of-service (POS) plans; and indemnity benefit plans. Companies usually offer a number of such plans and each may operate dozens of them.
HMO plans, sometimes called 'closed system' plans, have the most active cost-containment features. Consumers choose a primary care doctor from the HMO's network of providers, who acts as a gatekeeper for any other medical services the consumer may need. PPO plans, also called 'open access' plans, allow consumers ...
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