2020 State of the Market

2020 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. This data includes providers with at least one managed care contract nationwide.

Every year, Zelis Network Analytics aggregates this provider data to paint a picture of the provider landscape in the United States. This year, our 2020 State of the Market report covers five lines of business:

  • Commercial
  • Medicare Advantage
  • Medicaid
  • HIX/ACA
  • Dental

Commercial Landscape

Our commercial market includes both individual and group health plans. We looked at physicians, MDs and DOs, contracted with at least one health plan in the US to determine the unique count of physicians in the US.

Commercial market MD and DO data comes from over 470 unique networks and 140 unique carriers.

YOY Physician Count

Physician Counts by State

Medicare Advantage Landscape

For our Medicare Advantage State of the Market, we looked at physicians (MDs and DOs) contracted with at least one managed Medicare Plan in the US to determine the count of physicians accepting Medicare Advantage plans in 2020.

Medicare market counts come from 275 unique networks and 98 unique carriers.

Year-Over-Year Physician Counts

Physician Counts by State

Physician Count Comparison Between Medicare and Commercial

Medicaid Landscape

For our Medicaid State of the Market analysis we looked at the unique physician counts (MDs and DOs) contracted with at least one Medicaid managed care organizations in the United States.

Our dataset includes 253 unique networks from 136 unique carriers.

Eleven states do not have Managed Medicaid: Alabama, Arkansas, Connecticut, Idaho, Maine, Montana, North Carolina, Oklahoma, South Dakota, Vermont, and Wyoming.

Physicians Contracted with Medicaid MCOs by State

Physician Count Comparison Between Medicaid and Commercial

HIX / ACA Landscape

For our ACA Exchange State of the Market analysis we looked at payers offering plans on the PPACA public online exchanges in the United States to determine the number of networks being offered.

Participation is up in 2020, with almost 100 new networks across the United States.

HIX/ACA Number of Networks by State

Dental Landscape

For the Dental State of the Market landscape, we looked at dental providers contracted with at least one dental plan in the United States to determine the unique count for 2020.

The dataset included 52 unique networks from 31 carriers.

Dental Year-Over-Year Provider Counts

Dental Providers by State

Changing State of the Market

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

  • Continued popularity and shift towards high-performance and value-based care networks
  • Return of major players to the HIX/ACA market
  • General lowering of premiums for on-exchange plans
  • Growth of the Medicare Advantage market

With all these changes and more, it is essential to have access to tools that allow you to react and adapt to the evolving landscape. Zelis Network Analytics’ analytical toolset and comprehensive provider database enable powerful insights that lead to actionable improvements and better network outcomes. Let Zelis provide you confidence in your network and peace of mind for your provider data.

Interactive Carrier Dashboard

Our interactive dashboard maps allows you to easily see a list of carriers defined for a line of business. The map, broken down geographically by state, allows you to view a list of carriers for the selected region. You can select either one or multiple states, and Network360 Analytics Suite clients may find this interactive map under help within the platform. If you do not have access to the Network360 Analytics Suite, click here for the interactive map.

Where Does Zelis Data Come From?

Zelis 2020 | Zelis Network Analytics
Our data is directly sourced from carriers’ online directories and represents a snapshot of key market players in the US. We include providers with at least one managed care contract nationwide, and the underlying data is updated on a quarterly basis. This analysis looks at data from Q2 of 2020.

Our 2020 State of the Market provider counts cover four lines of business:

2020 State of the Market provider counts

Medicare Advantage
Research was conducted by our research analyst to identify the carriers offering Medicare Advantage plans and the networks being used to support these plans.

HIX / ACA
Research was conducted by our research analyst to identify the carriers and networks offered by the PPACA’s State and Federal Exchanges. The CMS PUFs were used in this analysis for states on the Federal Exchange.