Worcester, MA Market Overview
HealthLeaders Interstudy, December 2011, Pages: 33
When the state implemented healthcare reform in 2006, the law addressed only access. Since 2006, state reform has reduced the uninsured rate to below 3 percent and brought nearly 400,000 more residents under healthcare coverage statewide. But that decrease in the number of uninsured residents came with a price, and insurers have felt the pinch as the state clamped down on premium increases while cost of medical services continue to rise. Lawmakers are expected to introduce payment reform legislation in 2011, seeking to implement global capitation payment systems that tie outcomes to reimbursements. As the next 12 months unfold, hospitals and physicians in Worcester will be pushed to trim costs. In October of 2010, the largest health system in the market announced it was cutting operating costs, citing pressure from health plans, lower patient volume and acknowledging that the call for cost controls will intensify in 2011. Meanwhile, health plans in the market are using provider tiering to steer members to physicians and facilities meeting quality and cost benchmarks. Such efforts matched with an intense debate over cost controls point to challenging market for providers who will be pushed to enhance efficiency and performance.
Questions Answered in This Report
The highly consolidated Worcester health systems sector faces significant challenges over the next year as pressure from lawmakers and insurers to rein in costs increases. Legislation passed in 2010 mandates health plans offer narrow network in the small group and individual health plan segments. Which local hospital will be considered a Tier 3 facility? Which hospital may be the latest to be purchased by a for-profit company? Which health system announced that it would cut staff recently as part of efforts to trim operating costs?
Physicians feel their working environment is deteriorating and that physician supply shortages in the Worcester market are at urgent levels for some specialties as well as for primary care. Which medical group absorbed a prominent cardiology practice? Which medical group operates a patient-centered medical home project aimed at patients with diabetes? Which specialties in the Worcester region are deemed to have a shortage of physicians?
Despite the increase in covered lives since the state adopted healthcare reform in 2006, Massachusetts insurance plans have been losing money, their margins are shrinking, and their medical loss ratios are already well over what federal healthcare reform would require. Which health plans lead the Worcester market in terms of total lives covered? Which health plan has nearly 35 percent of its enrollment based on a global capitation reimbursement model? Which health plan is closely linked to one of the region’s largest medical groups?
Metrics
- Key market indicators and leading organizations among health systems, physicians and health plans
- Health systems’ market share
- Income, revenue, enrollment and pharmacy spend for leading health plans
- Demographics
Scope: Worcester, which covers Worcester County
Primary Research: Analysis of HealthLeaders-InterStudy data, Billian’s HealthDATA, local and state news and industry reports and interviews with local healthcare executives
Market
Management Summary
Health Systems & Hospital
Physicians
Health Plans
Medicaid/Medicare/Uninsured
Pharmacy
Legislation
Employers
Demographics & Statistics
Questions Answered In This Report
Financial pressures did not have a significantly negative impact on UMass Memorial Health Care, but new affiliations became attractive options for two smaller hospitals. Which hospital closed its inpatient beds and became a satellite of another community hospital in 2009? Which community hospital pursued an affiliation with a national for-profit hospital corporation? Which two organizations began exchanging clinical data in the regional health information exchange?
Worcester-area physician groups have embraced electronic medical records, contributing to the state’s ranking as No. 1 for e-prescribing. Which multispecialty group went paperless in the fall of 2009? How many providers across the state have signed on to Blue Cross and Blue Shield of Massachusetts’ Alternative Quality Contract, featuring global payments and performance bonuses? Which organization opened Worcester’s first walk-in medical clinic that operates after hours with a physician on site?
Massachusetts has the highest health insurance premiums in the country, attracting attention from state leaders. What kind of payment system did the state commission recommend for healthcare in the commonwealth? What provisions in a proposed legislative bill to help small businesses purchase insurance has drawn opposition by physicians, and why? Which insurers active in the Worcester area made the U.S. News and World Report’s list of top 10 commercial health plans in 2009?
Metrics
- Key market indicators and leading organizations among health systems, physicians and health plans
- Health systems’ market share
- Income, revenue, enrollment and pharmacy spend for leading health plans
- Demographics
- Scope
Worcester Market, which includes the Worcester County in Massachusetts.
Primary Research
Analysis of HealthLeaders-InterStudy data, Billian’s HealthDATA, local and state news and industry reports and interviews with local healthcare executives
- Associated Industries of Massachusetts
- Blue Cross Blue Shield of Massachusetts
- Central Massachusetts Independent Physicians Association
- Fallon Clinic
- Fallon Community Health Plan
- Group Insurance Commission
- Harvard Pilgrim Health Care
- Milford Regional Medical Center
- St. Vincent Hospital (Vanguard Health Systems)
- Tufts Health Plan
- UMass Memorial Health Care
- UMass Memorial Medical Group
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