MANASQUAN, NJ -- The size and shape of the managed care industry, determined by "players" in terms of numbers of covered lives, ranges from a handful of market dominating behemoths to more than 300 health plans with fewer than 20,000 members, based on a new review by The Managed Care Information Center (MCIC).
The review of health plans included in the database of The National Directory of Managed Care Organizations, included specialty health plans in the statistics, said Robert K. Jenkins, CEO of the Managed Care Information Center (MCIC)which produces the database.
There are 224 plans with 150,000 members up to more than one million. Some 197 plans are in the 50,000 to 150,000 segment and 121 with members in the 20,000 to 50,000 range, MCIC research found.
Among the largest MCOs across the country are plans such as Aetna, 13 million members; Beech Street Corporation, 17.6 million; CIGNA, 12 million; WellPoint Health Networks, 10.1 million; United Healthcare, 9.085 million; Kaiser Permanente, 8.1 million; and Humana, 6.6 million members.
Plan enrollment size will shortly shift again following the mergers of Anthem with Wellpoint Health Networks, and United HealthGroup and MAMSI, Jenkins explained. Those mergers were recently announced and are pending regulator approvals.
The figures do not represent the entire universe of MCOs, Jenkins said. There are some 1,750 MCOs profiled in the new edition of The National Directory of Managed Care Organizations.
MCIC staff said gathering enrollment data on PPOs is difficult. Also, the review does not include utilization review organizations, TPAs or PBMs.
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Analysis of the Managed Care Industry
Based On Health Plan Members
1 million to more than 10 Million: 52
500,000 to 1 Million: 46
300,000 to 500,000: 45
150,000 to 300,000: 88
50,000 to 150,000: 197
20,000 to 50,000: 121
20,000 and under: 379
Note: The figures include HMOs, PPOs, Medicare, Medicaid, and specialty health plans.
Source: The Managed Care Information Center research drawn from the database of The National Directory of Managed Care Organizations. Copyright 2003.
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|
Major Managed Care Plans
|
|
Health Plan
|
Headquarters
|
Members |
|
Aetna
|
Hartford
|
13 million |
|
Beech Street Corporation
|
New York City
|
17.6 million |
|
WellPoint Health Networks
|
Thousand Oaks, Ca.
|
14 million |
|
CIGNA HealthCare
|
Philadelphia
|
12 million |
|
United Healthcare
|
Minneapolis
|
9.085 million |
|
Kaiser Permanente
|
Oakland, Ca.
|
8.1 million |
|
Humana
|
Louisville
|
6.6 million |
Note: These figures include in some instances Medicare. Medicaid and Indemnity plans as reported by the MCOs.
Source: The Managed Care Information Center research drawn from the database of The National Directory of Managed Care Organizations. Copyright 2003.
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