Managed Health Care Services: Market Research Report

December 2011 | 79 pages | ID: M8255F2FC60EN
Global Industry Analysts, Inc

Abstracts

The global outlook series on Managed Health Care Services provides anecdotes, market briefs, and concise summaries of research findings.

The report analyzes the growth drivers and market challenges, and reviews the noteworthy strategic corporate activity of the recent past.

The report also discusses various types of managed care organizations and programs.

A detailed review of the United States market is provided in the report, along with brief discussions on European, Australian and Hong Kong markets among others.

Also included is an indexed, easy-to-refer, fact-finder directory listing the addresses, and contact details of 262 companies worldwide.

Contents

1.INDUSTRY OVERVIEW

Market Overview
Quick Facts
Managed Care Market Recovers from Recession
Factors Impacting Managed Care Market
Managed Care Organizations - Impediments and Drivers
Healthcare System in Developing Countries
Sustainability Helps to Strike a Balance
US Health Insurers Eye Overseas Markets

2.PRODUCT OVERVIEW

Managed Health Care – A Conceptual Definition
Benefits
Managed Health Care – Historical Perspective
Managed Care Organizations (MCOs)
Managed Care Services for Healthcare Providers
Cost Reducing Managed Care Techniques
Managed Care Approaches

3.TYPES OF MANAGED CARE

Types of Network-Based Managed Care Programs
Health Maintenance Organizations (HMOs) – An Introduction
Features of HMOs
History of Health Maintenance Organizations
Types of HMOs
Primary Care Physician (PCP)
Staff/Group Model HMOs
Fee for Service Plan (FFS)
Independent or Individual Practice Association (IPA)
Preferred Provider Organizations (PPO)
Point-Of-Service Plans (POS)
Other Managed Care Programs
Physician-Hospital Organizations (PHOs)
Different PHO Structures
Prescription Drug Programs
Dental Specialty Programs
Managed Care Under Indemnity Insurance Plans
Stop Loss Arrangements
Mixed or Network Model HMO
Exclusive Provider Organization (EPO)
Consumer Driven Health Plans (CDHPs)

4.STRATEGIC CORPORATE DEVELOPMENTS

5.PRODUCT/SERVICE LAUNCHES

A REGIONAL MARKET PERSPECTIVE

1.THE UNITED STATES

Managed Care – An Introduction
Cost Control through Managed Care
Managed Care Vs Conventional Insurance
Recession and Managed Care Market
Managed Healthcare Market – On a Recovery Mode

Table 1. US Current and Future Analysis for Managed Healthcare Services Market Analyzed with Annual Revenue Figures in US$ Billion for the Years 2010 through 2015

Healthcare Costs Continue to Escalate
Stimulus Bill Offers Aid to Healthcare Industry
Impact of Healthcare Reforms
Managed Healthcare Providers Shift Focus to Third World Countries
Managed Care Enrollments Improve

Table 2. US Managed Healthcare Market (2010): Number of Enrollments in Million by States - California, New York, Pennsylvania, Texas, Florida, Illinois, Ohio, Michigan, Massachusetts, New Jersey and Others

Managed Healthcare Companies Adopt New Strategies to Curb Rise in Healthcare Costs
Medicaid Managed Care – Major Care Delivery System

Table 3. Medicaid Enrollments by Plan Type (2009): Percentage Share Breakdown of Total MCO Members for Medicaid HMOs, PCCMs, PHPs, and HIOs

Table 4. US Managed Medicaid Market (2009): Leading Health Plans Ranked by Number of Enrollments (In Thousand)

South Offers Potential for Medicaid Managed Care Growth

Table 5. Medicaid Managed Care Enrollments by State (2009): Percentage Share Breakdown for California, New York, Texas, Florida, Pennsylvania, Michigan, and Others

Rising Medicaid Costs Drive Expansion of Managed Care
States Encourage Shift to Managed Care
Medicare Managed Care – Overview

Table 6. % of Medicare Expenditure Allocated to Managed Care in the US (2006-2009)

Table 7. US Managed Medicare Market (2009): Leading Health Plans Ranked by Number of Medicare Enrollments (In Thousand)

Medicare Advantage

Table 8. Medicare Advantage Enrollments in the US (2011): Percentage Share Breakdown by State for California, Florida, New York, Pennsylvania, Ohio, and Others

Table 9. Medicare Advantage Enrolments in the US (2010): Percentage Share Breakdown by Plan Type - HMO, PPO, PFFS and Others

Table 10. Medicare Advantage Healthcare Plans in the US (2010): Percentage Share Breakdown of Number of Available Plans for HMO, PPO, PFFS and Others

Table 11. Medicare HMO Enrollments by Region (2009): Percentage Share Breakdown for Pacific, Mid-Atlantic, South Atlantic, South Central, East North Central, Mountain, West North Central, and New England

Rising Cost of Healthcare for Employers
Employers Strategize to Reduce Costs
PPACA to Benefit Medicaid Enrollees
PPACA Reforms Drive New Collaborations
Challenges Impede Hospital-Physician Integration
Consumer-Driven Health Plans - Gaining Prominence
HMO Market – An Overview
Disease Management Programs Propel HMOs Growth
HMOs’ Witness Rise in Rates
HMOs and PPOs – A Comparison

Table 12. Number of Operating Plans for HMOs and PPOs (2009)

Competitive Landscape

Table 13. Leading Plans in the US HMO Market (2009): Ranked by Number of HMO Enrollments (in Thousands) for Kaiser Foundation Health Plan Inc., AETNA Health Inc., Blue Shield of California, Coventry Health and Life Insurance Company, Blue Cross Blue Shield of Massachusetts, and Blue Cross and Blue Shield of Illinois

Reinsurance Market - Overview
Dental Managed Care Market
Competitive Scenario
Hospitals Restructure as PHOs to Become ACOs
Pharmaceutical Industry Places Emphasis on Efficient Marketing Strategies
Competition

Table 14. Leading Health Plans in the US Managed Healthcare Market (2010): Number of Enrollments in Million for UnitedHealth Group, WellPoint, Inc., Aetna Inc., Health Care Service Corporation, CIGNA HealthCare Inc., Kaiser Permanente, Humana Inc., Health Net Inc., Blue Cross Blue Shield of Michigan, and Highmark Inc.

Table 15. Leading PPO Networks in the US (2009): Ranked by Number of Enrollments (In Thousand) for Blue Cross Blue Shield of Michigan, AETNA Health Inc., Blue Cross and Blue Shield of Florida Inc., Blue Cross and Blue Shield of Illinois, Blue Shield of California, and CIGNA HealthCare, Inc.

2.JAPAN

Healthcare System - Overview

3.EUROPE

Healthcare Market – An Overview
Managed Care Market
Corporate Layoffs Affects Managed Care Market

3A.GERMANY

Managed Healthcare System - Overview
GP Model Receives Mixed Response

4.ASIA-PACIFIC

4A.AUSTRALIA

Australia - A Healthcare Perspective
Mode of Healthcare Delivery
Funding of Healthcare
Challenges Ahead - Australian Managed Healthcare
The Path Ahead

4B.HONG KONG

Market Overview
Growth Driving Factors
MCOs Devise Newer Strategies
Other Strategies
Market Challenges

4C.SINGAPORE

Promising Future for Managed Care

5.LATIN AMERICA49GLOBAL DIRECTORY