This 33rd edition of the Guide to U.S. HMOs & PPOs profiles 903 managed care organizations in the United States, with current, comprehensive information for HMO, PPO, POS, and Vision & Dental Plans. Comprehensive coverage-from state listings to consolidations in the health insurance industry—is the cornerstone of this new edition. All entries have been reviewed and updated.
In addition to detailed profiles of Managed Healthcare Organizations, this edition includes:
- Health Insurance Coverage in the United States: 2019—a 21-page report based on data from the Current Population Survey Annual Social and Economic Supplement (CPS ASEC) and the American Community Survey (ACS), with maps, charts, tables, including insurance trends and state comparisons;
- Small Area Health Insurance Estimates: 2018—thirteen pages of maps, charts and statistics covering states and counties based on the U.S. Census Bureau’s Small Area Health Insurance Estimates (SAHIE);
- National Health Interview Survey, 2019—a nine-page report presenting full-year estimates of health insurance coverage for the civilian non-institutionalized U.S. population based on data from the January–December 2019 National Health Interview Survey (NHIS)
- State Statistics and Rankings section with state-by-state numbers of individuals covered by type of health plans, and state ranking by number of individuals enrolled in health plans.
In addition to new listings and updated profiles, users will find reflection of several mergers in the health industry, including:
- Meridian Health Plans of Michigan and Illinois and MeridianRx were acquired by WellCare
- The Lourdes health network in New Jersey joined Virtua Health
- Neighborhood health plan was rebranded as Allways Health Partners
- Boston-based Partners HealthCare was rebranded as Mass General Brigham
Plan profiles are arranged alphabetically by state. The first page of each state chapter is a State Summary chart of Health Insurance Coverage Status and Type of Coverage by Age. This chart includes a number of categories, from “Covered by some type of health insurance” to “Not covered at any time during the year.”
Directly following the State Summary, plan listings provide crucial contact information, including key executives, often with direct phones and e-mails where available, fax numbers, web sites and hundreds of e-mail addresses. Each profile provides a detailed summary of the plan, including the following:
- Type of Plan, including Specialty and Benefits
- Type of Coverage
- Type of Payment Plan
- Subscriber Information
- Financial History
- Average Compensation Information
- Employer References
- Current Member Enrollment
- Hospital Affiliations
- Number of Primary Care and Specialty Physicians
- Federal Qualification Status
- For Profit Status
- Specialty Managed Care Partners
- Regional Business Coalitions
- Employer References
- Peer Review Information
- Accreditation Information
In addition to the detailed front matter, state statistics, and comprehensive plan profiles, the Guide to U.S. HMOs & PPOs includes two Appendices and five Indexes.
- Appendix A: Glossary of Health Insurance Terms— Includes more than 150 terms such as Aggregate Indemnity, Diagnostic Related Groups, Non-participating Provider, and Waiting Period.
- Appendix B: Industry Web Sites—Contains dozens of the most valuable health care web sites and a detailed description, from Alliance of Community Health Plans to National Society of Certified Healthcare Business Consultants.
- Plan Index: Alphabetical list of insurance plans by seven plan types: HMO; PPO; HMO/PPO; Dental; Vision; Medicare; and Multiple.
- Personnel Index: Alphabetical list of all executives listed, with their affiliated organization.
- Membership Enrollment Index: List of organizations by member enrollment.
- Primary Care Physician Index: List of organizations by their number of primary care physicians.
- Referral/Specialty Care Physician Index: List of organizations by their number of referral and specialty care physicians.
The Guide to U.S. HMOs and PPOs is an invaluable resource for anyone within the healthcare industry, a much-used marketing tool for companies who provide materials and services to the managed care industry, and a useful reference for consumers seeking education and information about the world of managed care. This one-stop source has proven to be the premier guide in its field, containing an unprecedented amount of up-to-date information in a clear and easy-to-use format.
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