Walmart, GM should be 'wake-up call' for private insurers

Four of the nation's largest managed care organizations may lose dominance in the employer health insurance market if they don't innovate ways to compete with employers, according to an Oct. 5. Leerink brief.

Leerink analysts said managed care companies like UnitedHealth Group, Anthem, Aetna and Cigna "have their work cut out for them." Analysts added that "meaningful action would likely involve less cross-subsidization of the more lucrative and growing Medicare Advantage product through self-insured network contracting, and more innovative approaches and investments on both provider contracts and technology-enabled member engagement and analytics."

Employer-sponsored health plans cover 155 million Americans, or nearly half of the U.S. population, while private spending reflects more than a third of total healthcare spend. As healthcare spending is anticipated to grow 5.5 percent each year on average from 2017-26, Leerink analysts said employers are increasingly driving change in the market to reduce their own costs.

"Large self-insured employers have contracted directly with providers in an effort to lower costs and better coordinate care," according to the brief, which cited relationships like Detroit-based Henry Ford Health System's contract with General Motors and Walmart's Centers of Excellence program.

"Nearly 80 percent of large employers have said they will use COEs by 2019, while 22 percent expect to directly contract with health systems," according to the brief.

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