State of the Market 2018 Medical

Zelis Network Analytics collects provider network data from hundreds of plans for thousands of provider networks. By aggregating this provider data, we can paint a picture of the medical provider landscape in the United States.

STATE OF THE MARKET OVERVIEW

Zelis Network Analytics collects provider network data from hundreds of plans for thousands of provider networks. This data represents a snapshot of key market players in the United States and includes providers with at least one managed care contract nationwide. By aggregating this provider data, we can paint a picture of the medical provider landscape in the United States.

MEDICAL PROVIDER LANDSCAPE

MEDICAL PHYSICIANS

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.

  • In 2018 there were 796,293 physicians
  • In 2015 there were 791,107 physicians

Figure 1_All MDs and DOs by state

All MDs and DOs by county

MEDICAL PROVIDER TO POPULATION RATIOS

We also compared the physician provider population to the population of the United States to determine the provider to population ratio.

Provider to Population National Average

  • In 2018 the provider to population ratio was 1:409
  • In 2015 the provider to population ratio 1:405

This ratio varies greatly from state to state and county to county.

Figure 3: Provider to Population ratio

The states with the most providers aren’t necessarily better able to serve the populations of those states. In fact, Texas, which was in the top 3 states for the most providers, is in the bottom 3 for provider-to-population ratio; while Vermont, which fell in the bottom 3 for the number of providers, is in the top 3 for provider-to-population ratio.

Figure 4: Provider to population raito

PROVIDER COUNTS & REFERENTIAL SOURCES

We are often asked how our provider universe compares to that of other sources of provider data; so, we compared our count of physicians (MDs and DOs) contracted with at least one managed care company in the United States to several referential data sources. The reference source counts provide a baseline for understanding the range of what we expect for a reasonable provider count. Differences in timing and counting methodology (detailed in the Sources section) lead to some variability, but the Zelis Network Analytics counts are right in line.

Figure 5: Provider to Population by County

CHANGING HEALTHCARE LANDSCAPE

As healthcare in the United States continues to change, it is important to keep an eye on the provider landscape as it affects and is affected by new developments in managed care.

  • Increased use of narrow, tiered, and local or micro- networks to control costs
  • Greater focus on up-to-date and accurate provider network data
  • Increased attention on network access and adequacy
  • 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.

SOURCES

Zelis 2018 | Zelis Network Analytics

Zelis US Physicians with at Least One Managed Care Contract

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 first quarter of the year.

KFF 2017 | The Henry J. Kaiser Family Foundation

Total Professionally Active Physicians

Data includes currently active allopathic physicians (MDs) and osteopathic physicians (DOs).

Data Source

Special data request for information on active state licensed physicians from [Redi-Data, Inc] (http://www.redidata.com/), October 2017.

AAMC 1 | Association of American Medical Colleges

Active Physicians

Physicians (federal and nonfederal) who are licensed by a state are considered active, provided they are working at least 20 hours per week. Physicians who are retired, semi-retired, temporarily not in practice, not active for other reasons, or have not completed their graduate medical education are excluded. Active physicians include those working in direct patient care, administration, medical teaching, research, or other non-patient care activities. Active physicians include those with a Doctor of Medicine (M.D.) or a Doctor of Osteopathic Medicine (D.O.).

Data Source

Physician data are from the 2017 American Medical Association (AMA) Physician Masterfile (December 31, 2016).

AAMC 2 | Association of American Medical Colleges

Active Patient Care Physicians

This group is a subset of active physicians. It comprises only those physicians whose self-reported type of practice is direct patient care.

Data Source

Physician data are from the 2017 American Medical Association (AMA) Physician Masterfile (December 31, 2016).

FSMB | Federation of State Medical Boards

Actively Licensed Physicians

A Census of Actively Licensed Physicians in the United States, 2016. State counts are based on physician data recorded by the FSMB using state medical board license files from 2016 and reflect the number of physicians with an active license. Resident physician licenses were excluded when such license could be identified. Physician counts by state do not add up to 953,695 because some physicians maintain active licenses in more than one jurisdiction.

Data Source

2016 FSMB Census of Licensed Physicians.

U.S. Census Bureau, Population Division

U.S. Population Estimates 2017

Estimates are based on the 2010 Census and reflect changes to the April 1, 2010 population due to the Count Question Resolution program and geographic program revisions. All geographic boundaries for the 2017 population estimates series except statistical area delineations are as of January 1, 2017.

Data Source

For population estimates methodology statements, see http://www.census.gov/programs-surveys/popest/technical-documentation/methodology.html.

 

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