DUBLIN–(BUSINESS WIRE)–The «Michigan Health Market Review 2022» report has been added to ResearchAndMarkets.com’s offering.
In the second year of COVID-19, HMO profits tumble from record levels, as enrollment continues to grow.
After posting record profits in 2020, Michigan HMOs saw their profits fall sharply as health care utilization and medical claims began to return to pre-COVID levels. Enrollment in Medicaid and Medicare plans continued to grow through the first quarter of 2022.
This report examines financial metrics and enrollment trends in Michigan and five other states and weaves that data together with insights about competitive strategies in the market. The Part Two report for Michigan will focus on the financial performance, inpatient utilization and competitive strategies of the hospital systems in the state.
Key findings in the new report:
- Michigan HMOs reported a net income of $44.1 million in 2021, 92% less than in 2020, when HMOs had record-breaking profits. In 2020, HMOs had a combined net income of $551.2 million, as utilization and medical claims fell well below projections. While most HMOs remained profitable in 2021, two large HMOs, Blue Care Network and Health Alliance Plan, reported combined losses of $210 million. UnitedHealthcare Community Plan and McLaren Health Plans both improved their profits in 2021. Priority Health, now including the Total Health Care HMOs, was strongly profitable, as was Molina Healthcare. Blue Cross Blue Shield of Michigan had net income of $301.8 million in 2021, down from $315.5 million in 2020.
- Medicaid HMO plans were the most profitable, reporting underwriting (before investment revenue and taxes income of $279.8 million, up almost 50% from 2020. Four of them had underwriting margins of 7% or higher: McLaren Health Plan, Priority Health Choice, Total Health Care and Upper Peninsula Health Plan. Medicare Advantage plans, which have generally been strongly profitable, reported combined losses of $159.6 million, a major swing from underwriting income of $200.6 million in 2020. Blue Cross Blue Shield and three HMOs – Blue Care Network, Health Alliance Plan and Humana Medical Plan–had large losses on their Medicare Advantage plans, while Molina Healthcare and UnitedHealthcare Community Plan had strong profits. And after excellent profits on commercial plans (individual and employer groups) in 2020, Michigan HMOs saw their underwriting income drop from $136.1 million to a loss of $234.1 million. Three HMOs – Blue Care Network, Health Alliance Plan and Priority Health – had combined losses of $232.1 million.
- Enrollment in Michigan HMOs has grown by more than a half million since the beginning of the COVID-19 pandemic, with Medicaid and Medicare Advantage plans to enjoy the largest gains. Enrollment grew by 540,000 between the end of 2019 and the end of 2021. Medicaid plans alone added 437,000 members, while Medicare Advantage HMO grew by 121,000. As of the beginning of 2022, more than half of Michigan Medicare beneficiaries are in a private health plan. Priority Health has the largest Medicare HMO enrollment here, while Meridian, now owned by Centene, is the largest Medicaid HMO.
- Some growth in Medicaid plans occurred because states could not require verification of eligibility during the public health emergency, which is now extended into 2023. It is possible that a few hundred thousand Medicaid enrollees will lose their benefits then, although many may be able to get low-cost benefits as individuals at Healthcare.gov
- Competition in the Michigan health insurance market could be strongly affected by two developments. First, the state will likely begin a new procurement process for Medicaid HMOs in 2023, and the competition for these large contracts will be fierce, with incumbents and new entrants trying to get a piece of these billion-dollar contracts. Michigan used its last procurement to focus on progress toward key goals in the Medicaid program. Second, a settlement has been approved in an antitrust case brought against the Blue Cross Blue Shield Association and its member plans. Some Association rules that limited competition will be loosened and Blue Cross Blue Shield of Michigan could bid on employer groups in other states. At the same time, other Blue Cross plans can now bid on business in Michigan.
Key Topics Covered:
PART 1
1. Introduction
2. Market Structure
- Health Plans
- Provider Systems
3. Trend Review
- Health Plan Enrollment
- Medicaid Managed Care
- Medicare Plans
- Net Income
- Financial Results by Line of Business
- Provider Payments
- Health Plan Capital
4. A Look Ahead
PART 2
1. Introduction
2. Market Structure
3. Market Analysis
4. Detroit Area Hospitals
- Revenues and Net Income
- Inpatient Occupancy and Payer Mix
- Performance Bonuses and Penalties
5. Other Major Hospitals
- Revenues and Net Income
- Inpatient Occupancy and Payer Mix
- Performance Bonuses and Penalties
6. Health Plan Trends
- HMOs Hospital Admissions
- Health Plan Enrollment and Net Income
- Medicaid Enrollment by Region
- Effectiveness and Utilization of Care
7. A Look Ahead
Companies Mentioned
- Blue Care
- Blue Cross Blue Shield
- Health Alliance
- Humana Medical
- McLaren Health
- Molina Healthcare
- Priority Health
- UnitedHealthcare
For more information about this report visit https://www.researchandmarkets.com/r/pqrvwa
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