Top Managed Care Industry Trends 2020

25 Jun 2020

Scope of Global Managed Care Industry Reports-

Managed care plans are a type of health insurance which have contracts with healthcare providers and medical facilities to give hospital care at decreased costs to the patients. These providers construct the managed care network who decides how much patients planed care will pay. Managed care is mainly planned to decrease needless health care costs through different type of mechanisms such as incentives for physicians and patients to choose less costly forms of care, programs for reviewing medical relevance for specific services, increased beneficiary cost sharing, controls on inpatient admissions and stay time, introduction of cost-sharing incentives for outpatient surgery; contract selection with health care providers, and the thorough management of high-cost health care cases. The managed care program can be provided in different types settings such as Health Maintenance Organizations and Preferred Provider Organizations.

Global Managed Care Industry Market is valued at USD XX billion in 2019 and expected to reach USD XX billion by 2026 with the CAGR of XX over the forecast period.

Global Managed Care Industry Dynamics 

Increasing prevalence of chronic diseases, growing geriatric population, government initiatives on making healthcare industry more affordable and growing adoption of healthcare insurance among consumers are the major driving factors of managed care industry. Different than typical healthcare insurances, managed care enforces limitations on utilization by agreeing which practitioners and which services are covered, and frequently also the number of permissible visits. Managed care comes in many forms and new structures continue to develop, making service portfolio more diverse which boosts the managed care market. The market is more established in western region due to government policies and consumer awareness about the service, for instance, since more than 20 years, managed care has become the major form of health care in many parts of the USA.  Over 70 million Americans have been registered in HMOs (health maintenance organizations) and nearly 90 million have enrolled in PPOs (preferred provider organizations). It is popular among consumers and viewed as necessary for using healthcare services efficiently because it mainly helps in lowering the hospital cost and treatment costs. Many structures of managed care have evolved with time. For instance, now the types of HMOs comprise staff model, group model, network model, independent practice association (IPA), and mixed model HMOs. it depends on capitation and other incentives to control costs, along with the usage of nonphysician practitioners in lower-intensity treatments. The group practice structure of HMOs enables updated coordination between primary care and specialty practitioners. These types of improvement have boosted the market growth of managed care. The cost saving advantages of Managed care can be estimated from the fact that, organizations that are providing Medicaid programs with lower cost prescription drugs, leads to as much as USD 6.5 billion in net savings in fiscal year 2018, according to a recent report published by America’s Health Insurance Plans (AHIP)

Recent Development- Modernization of Medicaid in USA

Medicaid managed care plans of USA are modernizing telehealth solutions and telehealth coverage, addressing social elements of health, and providing access to care and informed provider selection for patients, specified a study conducted by the Menges Group for America’s Health Insurance Plans (AHIP).

The report found out that, Medicaid managed care plans cooperate with their state counterparts to provide good public private partnerships customized to meet the needs of each individual states in USA as well as the populations that are served by that states Medicaid program which shows the effectiveness of Medicaid program.

The report found that, one way in which Medicaid managed care plans had an advantage compared to fee-for-service plans was in managed care plan on telehealth solutions.

In USA most of the states were fairly hands off with this injunction. Only one plan made any specifications regarding the populations the telehealth tools must serve. Ultimately, Medicaid managed care plans centralized their efforts on telepsychiatry, remote monitoring, virtual urgent care and chronic disease management support

Recent Managed Care Industry Trends 2020

Managed Care Industry Trends 1- Business model transformation:

Multiple changes for example, reduction of additional funding from the Affordable Care Act are combining to provide resistance against profit pool business in healthcare. New business models that create substantial healthcare value will be critical in this resistance. For instance, payers are now considering the next generation managed care model with more engagement in care delivery which comprises integration of patient’s care journey are deemed as more profitable.

Managed Care Industry Trends 2- Healthcare reform:

The 2020 presidential election in USA is keeping healthcare in forefront, which is expected to affect managed care plans of this country significantly. Even if all main healthcare regulatory reforms have occurred in the aftermath of a recession, affordability issues experienced directly by consumers through cost sharing raise the demand of change in managed care system. Proposals and policies will evolve more, including “Medicare for All,” “Enhanced ACA,” or other substitutes, which results in high uncertainty and need scenario planning. However, a few general issues will also hinder the market, such as guaranteed issue without medical underwriting, catastrophic coverage for all, means-tested subsidies, and a managed care model with rising risk transfer to providers. It is expected that in 2020, in broader perspective payers, providers, and other service players who are working successfully in Medicare Advantage will have an advantage in future.

Managed Care Industry Trends 3- Healthcare ecosystems:

The rapid advancement in digital technology and artificial intelligence as well as machine learning will accelerates the changes in healthcare industry which also will positively affect the managed care industry. Major technology giants are engaged in a trillion-dollar battle to win share in the public cloud and to hold consumer mindshare and engagement. Because of this, they are financing billions of R&D dollars into their platforms to make services easily available among customers and for different types of applications such as predictive analytics, that accelerate innovation. Regulators are working on interoperability and freeing up data to be applicable around the patient. In turn, these digital advances create a synchronized environment of collecting data and analyzing them efficiently and automatically for the development of consumer-centric personalized health and social care ecosystems which also positively affect the managed care industry.

Managed Care Industry Trends 4- Medicaid Expansion:

Medicaid expansion is another trend in 2020, that will affect the managed care market. Though Medicaid expansion legislation was passed in 2018 and come in to effect in 2019, referendums and legislation are still incomplete in many places throughout the United States such as Kansas, North Carolina, and Wyoming. Referendums for expansion are anticipated on the 2020 ballot in at least four states. The Medicaid expansion legislation greatly affects healthcare organizations and patients because it means more people have access to healthcare than previous policies. Health systems expected to be ready to care for this increasing number of patients without negotiating quality and also confirming they achieve CMS standards of care in order to obtain reimbursements. In turn, critical care hospitals and small healthcare organizations started merging and contracting specialty services with other companies.

Managed Care Industry Trends 5- Consumerism:

The patients are taking their care decisions based upon costs, their knowledge of the full scope of options available to them based on research and trustworthy sources of information from internet, and by applying their use of technologies. Within this trend, consumers are progressively searching for the best value at the lowest cost that is the most suitable to their lifestyle. In turn, healthcare providers have been asked by government bodies to respond with price transparency and effective quality outcomes. Other than that, new gadgets such as wearable devices help consumers in managing certain conditions.

With over 80% of consumers researching their healthcare choices online and the increased dependence on the reputation of a hospital, physician or provider before making healthcare decisions, costs and publicly reported quality scores are important. In many countries, the Centers for Medicare and Medicaid Services (CMS) has planned, but not finalized such as new price transparency measures where all hospitals will have to show the prices they negotiate with payers for standard services and items in order to inform patients about general costs.


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