The Health Plan Market Calculus

For the executive teams of most provider organizations, working with health plans is often a struggle. Health plans manage the benefits of more than half of all Americans (see The Health Plan As Elephant). More than 80% of Medicaid beneficiaries now have their benefits managed by health plans (see About 85% Of Medicaid Beneficiaries Enrolled In Managed Care). Enrollment in Medicare Advantage surpassed traditional Medicare for the first time, meaning these consumers now also have managed care coverage through a health plan. Thirty of the 60 million consumers eligible for Medicare are enrolled in a private plan (see Half Of . . .