The healthcare industry is constantly evolving, and it’s crucial to stay up-to-date with the latest trends and data to ensure that you’re making informed decisions for your organization. That’s why each year we dive into the insights shared from our 2023 State of the Market report.

In this blog, we’ll discuss provider insights covering medical, Medicare Advantage, Medicaid, exchange (HIX), and dental market segments and explore trends in physician counts, growth in carrier participation and available networks, and an assessment of physician supply and member access.

Physician / hospital counts and access to care

The US medical market is constantly changing, and staying up-to-date with the latest trends and data is essential for making informed decisions about healthcare access and provider recruitment. But with 858,000 physicians in the US in 2022, and a net loss of 11 hospitals, monitoring the healthcare market is crucial.

Regular access to providers ensures that patients receive the care they need. Access to providers currently varies widely on a state-by-state basis, with Washington DC, Massachusetts, and New Hampshire ranking highest for access to both primary care and specialist providers.

Overall, this data highlights the importance of understanding healthcare provider counts and access on a state-by-state basis when developing healthcare network strategies and recruitment efforts. By keeping up with the latest trends and data in the medical market, we can ensure that patients receive the care they need and healthcare providers are able to provide high-quality care.

Managed Medicare and Medicaid plans: growth, competition, and access

Over the last decade, managed Medicare and managed Medicaid plans have grown in popularity, with enrollment in both programs experiencing strong growth year after year.

According to the Kaiser Family Foundation, in 2020, nearly 48% of the Medicare eligible population (aka more than 28 million Medicare beneficiaries) were enrolled in a Medicare Advantage plan. This number has continued to rise, with current enrollment topping 30 million in 2022, a growth in enrollment of 46% from 2017 to 2022.

The Congressional Budget Office projects that by 2030, over half of all Medicare beneficiaries will be enrolled in Medicare Advantage plans, a number that is rapidly approaching.

Managed care organizations, like United Healthcare and Centene, are expanding their networks, with over 700 new networks offered in 2022. But while the overall number of contracted physicians and hospitals has increased, access to providers varies widely on a state-by-state basis, with one provider participating with managed Medicare organizations to every 76 Medicare-eligible individuals, one primary care physician to every 179 individuals, and one specialist to every 118 individuals.

Managed Medicare and Medicaid plans offer a number of benefits to both patients and providers, including increased access to care, lower costs, and improved health outcomes. And as managed care continues to grow in popularity, it will be important for organizations to continue investing in competitive strategies and ensuring access to quality care for all patients.

Enrollment and issuer trends in Affordable Care Act exchanges

The Affordable Care Act (ACA) was signed into law in 2010, with the goal of providing affordable health insurance coverage to millions of Americans.

One of the key components of the law was the creation of public health insurance exchanges or marketplaces, where individuals and small businesses could purchase health insurance plans. These exchanges were designed to increase competition among insurers and drive down costs, while also ensuring that individuals had access to quality health insurance.

The launch year of the exchanges was 2014, and it started off strong with 8 million enrollees. After a brief stagnation, enrollment grew 5% in 2021 and 21% in 2022, with 15 million enrollees.

This growth in enrollment is a positive sign, as it indicates that more individuals are accessing affordable health insurance coverage through the exchanges. It also suggests that the interest from issuers, or insurance companies, in participating in the exchanges is increasing.

Overall, there has also been a lot of variability and change in terms of issuer participation and networks being offered.

And as the emergency safety net put in place during the COVID-19 pandemic comes to a gradual end, as many as 15 million people may be kicked off Medicaid. As the healthcare landscape continues to evolve, it will be important to closely monitor these trends to ensure that individuals have access to quality, affordable health insurance coverage.

Dental provider and access point growth

The number of dental providers and access points in the United States has been on the rise over the past few years.

According to our recent study, there are currently around 183,000 unique dental locations in the United States, up from around 167,000 in 2018, representing an increase of around 9% over five years.

What’s interesting, however, is that the number of access points has been growing much faster than the growth in the number of providers or locations, with around 1.23 million unique dental access points in the US, up from just under 1 million in 2018, representing a growth of 23%. The number of locations per provider has also increased from 5.54 locations per provider to 6.22 locations per provider, a growth of 12%.

Dental supply currently varies significantly by state, with some having higher or lower supplies of dental providers. For general dentists, the ratio is around one general dentist for every 2000 people, while for dental specialists, the ratio is around one specialist for every 8000 people.

Overall, the growth in the number of dental providers and access points in the United States is a positive development, and patients should take advantage of this increased access to dental care.

Physician supply and shortages in Medicare and Medicaid: building adequate networks

Physician supply and shortages are often considered a concern in the healthcare industry, particularly in the Medicare Advantage and Medicaid markets.

Our 2023 State of the Market analysis compared commercial, Medicare Advantage, and managed Medicaid markets, as well as physician supply and geographic location. Results showed 86% of physicians are contracted with Medicare Advantage plans and 57% with managed Medicaid plans.

The differences in participation for general acute care hospitals are less dramatic, but it is important to mention that the limited supply of physicians in the Medicaid market may create challenges in building sufficient networks.

And while new providers are entering the market, only a small percentage are in rural or critical access counties. As such, recruitment efforts may need to be focused on providers who are contracting with other Medicare Advantage organizations and new providers in large metro and metro areas.

The wrap up

Overall, the insights shared in our 2023 State of the Market report emphasize the importance of staying up-to-date with the latest trends and data in the medical market to ensure that patients receive the care they need and healthcare providers are able to provide high-quality care.

To dive deeper into the report, download your own copy here or listen to our recent webinar.