Coalition for Specialty Care Access Report
Res Ipsa Loquitur (The facts speak for itself)
Notable Changes in the Chicago Area Managed Care Market - 1998
1. ENROLLMENT-overall enrollment in managed care products continues to increase for the market as a whole. Some carriers have experienced large shifts in business from one product of another (e.g., United Health Care).
- a. HMO carriers reported an average increase in enrollment of 8.0% (2.2 million lives).
- b. PPO carriers reported an average increase in enrollment of 12.55 (3.5 million lives).
2. PREMIUM-MARKET conditions forced local payers to freeze or reduce employer premiums for 1998. 1999 premiums have been raised with some carriers reporting double-digits increases.
3. CONSOLIDATION-PAYER consolidation began in early 1998, promises to continue through 1999.
- a. Humana/United Health Care Plans, Merger complete 10/1/98.
- b. Aetna/US Health purchased NYL Care Health Plans. Merger completed 10/1/98.
- c. American Health Care Providers purchases Maxicare of Illinois and Principal Health Care of Illinois, quickly making them one of the five largest HMO’s in the market.
- d. Blue Cross Blue Shield of Illinois assumed operations for failing Oxford Health Plans.
- e. Aetna/US Healthcare announced merger with The Prudential. Impact on local market uncertain.
4. PROVIDER CHANGE - many unique and unexpected changes show that the provider community will continue to evolve for some time as providers adjust to market forces an attempt to succeed under current managed care trends.
- a. Columbia/HCA exit Chicago market.
- b. Ravenswood Hospital Medical Center ends affiliation with Advocate Health Care and moves to full asset merger, effective 1/1/99.
- c. MedPartners dives itself of North Suburban clinic and will likely sell Mid-America Health Partners. Future of Glen Ellyn and Wheaton clinics and Suburban heights group uncertain.
- d. Evanston Northwestern Medical Group significantly improves market position by purchasing Evanston and North Chicago Humana staff model sites and by purchasing North Suburban Clinic from MedPartners.
- e. Westlake Community Hospital merges into Resurrection Health Care.
- f. Advocate Health Care experiences significant growth by purchasing the majority of Humana’s staff model clinics. Clinics are being opened to other payers. Success in revamping operations and performance of clinics will solidify Advocate’s position as the premier integrated delivery system in the market and will give them significant market power.
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