These are some of the key findings in Ohio Health Market Review 2020, the publisher's 15th report analyzing the health care insurance and provider markets in Ohio. The report describes key trends for those organizations and analyzes their competitive strategies.
The Report Finds:
- Medicaid HMOs in Ohio saw a sharp reduction in medical claims in the first half of 2020 and many improved profits. Five HMOs contracting with the state for Medicaid reported that their net income in the first half of 2020 was $334 million compared to a loss of $48 million for the same period in 2019. As claims dropped, their average medical loss ratio dropped from 87.9% in 2019 to 81.9% in 2020. Medicaid is the largest line of business for Ohio health plans and enrolled 2.3 million persons at the end of 2019. Medicaid HMOs added 210,000 members in the first half of 2020, as people who lost their jobs and health insurance turned to the program for coverage.
- Ohio Medicaid is making major changes in how it contracts with and pays managed care plans. In 2019, Ohio paid about $17 billion to Medicaid HMOs, making it a huge business opportunity. It recently launched a process to select contractors for the program beginning in 2022. The new contracts will focus on population health, reduce the role (and revenues) of the HMOs in plan administration, and enable the state to more closely manage market share. CareSource, the biggest Medicaid HMO in Ohio has been pursuing opportunities to contract for Medicaid managed care outside of Ohio, and its for-profit management company has received private equity investments to provide the capital needed to pursue that expansion.
- Hospital profitability in 2019 increased in all three major metropolitan areas and increased by 31% in the Columbus region. Based on data from Medicare hospital cost reports, the hospitals in the Columbus area had a combined 2019 net income of $1.558 billion, or 15.4% of their net patient revenues. That was 31% more than their combined net income of $1.187 billion in 2018. Nationwide Children’s had a net income in 2019 of $595.3 million, or 34.7% of net patient revenues. The OhioHealth hospitals had a net income of $565.9 million (15.8%) and the Ohio State University hospitals had a net income of $344.4 million (9.5% of revenues). Hospitals in the Cincinnati/Northern Kentucky/Dayton region had a combined net income of $1.309 billion in 2019 (11.4% of net patient revenues), up from $791.6 million in 2018. Premier Health, having closed Good Samaritan Hospital in Dayton in 2018, was the most profitable system, while Cincinnati Children’s, Christ, and the Kettering Health Network hospitals reported the strongest net income.
- In the Cleveland/Akron region, hospitals posted a combined net income in 2019 of $1.942 billion, or 12.6% of net patient revenues, up from $622 million in 2018. The Cleveland Clinic hospitals had a net income of $1.629 billion (19.9% of revenues), while the University Hospitals system had a net income of $299.7 million (8.3% of net patient revenues).
- Inpatient days decreased again for hospitals in the Cincinnati and Cleveland areas but increased in the Columbus area. Ohio hospitals continue to pursue growth strategies, spending billions on new facilities, both inpatient and ambulatory centers. They also have pursued mergers and acquisitions, with some deals going beyond the borders of the state.
- Ohio HMOs reported a 2019 net income of $282.1 million, or 1.3% of underwriting revenues, less than in 2018. The state’s six Medicaid health plans posted a combined underwriting income of $119.4million in 2019, or 0.7% of revenues, less than in 2017. Of the Medicaid HMOs, Aetna Better Health had the strongest margin in 2019 (8.0%), followed by Molina Healthcare (2.8%) and Buckeye Community (2.1%). CareSource, the largest health insurer in the state lost $1.9 million on its Medicaid plans in 2019 but made $27.9 million on its individual plans.
- In 2019, Anthem Blue Cross Blue Shield had an after-tax net income of $352.2million, or 5.9% of revenues, while Medical Mutual had a net income of $102.8 million, or 3.7%.
- Market Structure
- Health Plans
- Provider Systems
- Trend Review
- HMO Enrollment
- Medicare Plans
- Medicaid Managed Care
- Net Income
- HMO Financials by Line of Business
- Provider Payments and Administrative Expenses
- Health Plan Capital and Surplus
- Hospital Systems and Regional Submarkets
- Cincinnati-Northern Kentucky- Dayton
- Other Major Hospitals
- A Look Ahead
- Aetna Better Health
- Anthem Blue Cross Blue Shield
- Buckeye Community
- Cincinnati Children’s Hospital
- Christ Hospital
- Cleveland Clinic
- Good Samaritan Hospital
- Kettering Health Network
- Medical Mutual
- Molina Healthcare
- Premier Health
The reports analyzing state health care markets are intended to be a resource to health care organizations facing a full range of challenges but also seeking to identify and benefit from opportunities that present themselves.
This report is presented in three main sections. The first part, Market Structure, describes the major health insurers and hospital systems in the state, showing recent entrants and the high-level of consolidation that has occurred in both the health plan and provider markets. Market Trends, the next section, presents our analysis of enrollment trends and financial results for the health insurers. The last section contains our analysis of financial and inpatient utilization data on the hospitals in the state.
The analysis of health plan companies is based on their annual and quarterly statements filed with the Department of Insurance, including forms prescribed by the National Association of Insurance Commissioners and supplemental reports required by the state. The publisher also uses Medicaid data from the Department of State Health Services and Medicare health plan and hospital data from the Centers for Medicare and Medicaid Services. The publisher has that data together with insights that they have gained in interviews with dozens of leaders in health care organizations in the state.