Kaitlin Howard

By Kaitlin Howard

Kaitlin Howard is a researcher and writer producing insightful content across the healthcare revenue cycle. She has written and produced content for Zelis, Waystar, and Recondo Technology, as well as agencies. With a B.A. in English and Writing from University of Denver, Kaitlin stays current on market updates on claims management and healthcare payments, publishing a regular educational blog series on industry trends and Zelis offerings.

“Healthcare in the United States is constantly changing. I think everyone knows this, but our primary goal with sharing our State of the Market analysis each year is to help the industry, especially payers, understand where the market is going.”

– Jillian Carlile, Zelis Senior Product Analyst

The healthcare provider market has been in flux over the past few years with the challenges of the pandemic impacting healthcare operations. To help providers better understand and manage the challenges of this uncertain environment, Zelis releases an annual State of the Provider Network Market report.

In a recent podcast, Zelis Senior Product Analyst Jillian Carlile sat down with Kevin Tierney to explore the 2022 market insights for medical, Medicare Advantage, Medicaid, Exchange (HIX), and dental segments.

As always, we’ll discuss the highlights below, but you can listen to the full podcast here:

State of the Market Report: What is it?

Every year, Zelis aggregates provider network data from hundreds of payers for thousands of provider networks to paint a picture of the provider landscape in the United States.

This year, our 2022 State of the Market report covers five lines of business:

  • Medical
  • Medicare Advantage
  • Medicaid
  • Exchange
  • Dental

Healthcare in the United States continues to change with trends and regulation; thus, it is important to stay abreast of new developments in managed care.

This year, the key trends of importance are:

  • Managed care plan provider growth across all market segments
  • Medicare Advantage organization expansion
  • Volatility in Exchange network offerings
  • Stable Medicaid enrollment and provider participation
  • Minimal but consistent dental provider participation expansion

Additionally, challenges related to the limited physician supply in rural areas also has the potential to impact both payers and members.

For payers, this means more competition to recruit providers and possible challenges meeting network adequacy or access requirements in those areas. It also means, there is an opportunity for differentiation by utilizing more telehealth benefits to provider network coverage in these areas.

For rural members, this means it may become increasingly challenging to access care within a reasonable distance and appointment wait time.

The State of the Market report discusses these trends, leading to actionable improvements for better network outcomes.

The Data

One key point from this year was the increasing number of providers contracting with managed care plans across all market segments. But there was still some variation for different geographies and markets, especially in rural areas.

For example, in Medicare Advantage, there was a strong interest in Medicare Advantage plans from the Medicare eligible population, as well as significant growth in the number of Medicare Advantage organizations participating in the market.

Across the board, many Medicare Advantage organizations are expanding their footprints into new markets. With that, of course, came quite a bit of volatility in exchange network offerings, reaching 18% growth in the number of carriers offering exchange plans and 20% growth in the number of plan networks offered.

The Medicaid market remained stable in terms of enrollment and provider participation with Medicaid Managed Care organizations. But new Managed Medicaid states and Medicaid expansions have the potential to impact this market in the future.

The dental market also remained stable; however, as the growth of access points far outpaced that of actual providers and locations, there was access point inflation across the market.

And as these things usually go, the report came with a few surprises this year.

One of which was the result of the hospital analysis. Simply put, we saw more new hospitals than closures. This may be due, in part, to the increased interest in micro and satellite hospitals that are opened by larger health systems in smaller areas.

Although these micro hospitals typically have smaller footprints with fewer beds and offer fewer services than large general acute care hospitals, they offer a way to give more people access to care. And that’s a good thing in our books.

The second? Physician supply in specific geographic areas.

Approximately 10K brand new providers contracted with at least one health plan had a brand new NPI, but only 2% of those providers had rural or critical access locations.

Payer Impact

More competition. That’s all there is to it.

According to the data, there is a vital need to invest more in designing and implementing a competitive strategy. Just take a look at the recent news detailing Humana investing in Medicare Advantage.

Challenges related to the limited physician supply in rural areas could also increase the potential for competition within provider recruitment. But it also means there’s an opportunity for differentiation by utilizing more telehealth benefits to provide network coverage in these areas.

Member Impact

The increased payer participation means more plan and network options.

And while this is good, the sheer number of options can also be very overwhelming, especially when it is already challenging to find plan comparison tools and network options.

But the limited physician supply could lead to a lack of care within a reasonable distance, as well as a reasonable appointment wait time.

The Wrap Up

Our primary goal with sharing our State of the Market report each year is to help the industry, especially payers, understand where the market is going. And at Zelis, we offer solutions to help payers address some of the challenges we are seeing.

Want the specifics? Check out the full report.

On the go? We’ve got you covered. Listen to our webinar.

Interested in finding out how Zelis can support your organization? Connect with us.