2019 State of the Market Overview

Zelis Network Analytics collects provider network data from hundreds of payers for thousands of provider networks, maintaining the largest, most reliable demographic provider dataset in the United States.

2018 state of the market

Zelis Network Analytics collects provider network data from hundreds of payers for thousands of provider networks, maintaining the largest, most reliable demographic provider dataset in the

United States. This data includes providers with at least one managed care contract nationwide.

Every year we aggregate this provider data so we can paint a picture of the provider landscape in the United States.

Our 2019 State of the Market report covers five lines of business:

●  Commercial ●  Medicare Advantage ●  Medicaid Advantage Provider  ●  HIX / ACA ●  Dental

COMMERCIAL PROVIDER LANDSCAPE


In our Commercial State of the Market analysis we looked at the unique count of physicians (MDs and DOs) in the United States.

State of the Market Figures 1 and 2

 

MEDICARE ADVANTAGE PROVIDER LANDSCAPE


To put together our Medicare Advantage State of the Market analysis we looked at the unique count of physicians (MDs and DOs) contracted with at least one organization offering Medicare Advantage plans in the United States.

2019 MDs and DOs by State

MEDICAID ADVANTAGE PROVIDER LANDSCAPE


To put together our Medicaid State of the Market analysis we looked at the unique count of physicians (MDs and DOs) contracted with at least one managed Medicaid organization in the United States.

2049 MDs and DOs by State

HIX / ACA ADVANTAGE PROVIDER LANDSCAPE


We took a different approach in putting together our ACA Exchange State of the Market analysis. We looked at individual payers and networks available on the PPACA public online exchanges in the United States to determine the number of carriers offering networks.

Carriers by State

DENTAL PROVIDER LANDSCAPE


To put together our Commercial State of the Market analysis we looked at physicians (MDs and DOs) contracted with at least one managed care company in the United States to determine the unique count of physicians.

CHANGING STATE OF THE MARKET

As healthcare in the United States continues to change, it is important to keep an eye on the State of the Market as it affects and is affected by new developments in managed care, like:

  • Increased use of high-performance networks to control costs
  • Greater focus on up-to-date and accurate provider network data
  • Increased attention on network cost, quality, and access
  • Changes in physician workforce

With all these changes, it is important to have access to tools that allow you to adapt quickly to the changing landscape. Zelis Network Analytics’ leading-edge network analytics toolset and comprehensive, current provider database enable powerful insights and better network outcomes. Learn more.

2019 STATE OF THE MARKET WEBINAR

In Zelis Network Analytics’ (ZNA) webinar, State of the Market Analysis: 2 Experts Cover 5 Lines of Business in 25 Minutes, ZNA leverages its vast provider network database to paint a picture of the provider landscape and presents a more detailed analysis of many of the topics covered in this article. To view a recording click here.

INTERACTIVE CARRIER DASHBOARD

A highlight of this analysis is an interactive dashboard map, which allows you to easily see a list of carriers defined for the line of business and broken down geographically by state. The map allows you to select either one or multiple states and will provide a list of carriers in the selected region. Network360 Analytics Suite clients may find this new interactive map under help within the platform. If you don’t have access to the Zelis Network360 Analytics Suite, you can view the interactive map here.

WHERE DOES ZELIS GET THIS DATA?

Zelis 2019 | Zelis Network Analytics

Zelis US Physicians with at Least One Managed Care Contract

Source data represents a snapshot of key market players in the US. A product of Zelis’ network competitive intelligence services, it includes providers with at least one managed care contract nationwide. The underlying data is updated on a quarterly basis, but the analysis looks at data from the second quarter of the year.

Our 2019 State of the Market report covers five lines of business:

Commercial Medicare Medicaid Dental
Carriers ≈ 100 88 102 35
Networks ≈ 400 200 203 60

 

HIX / ACA

Research was conducted by the ZNA Insights team to identify the carriers and networks offered on the PPACA’s State and Federal Exchanges. The CMS PUFs were used in this analysis for states on the Federal Exchange.