This 32nd edition of Guide to U.S. HMOs and PPOs profiles 857 Managed Care Organizations in the United States, listing current, comprehensive information for HMO, PPO, POS, and Vision & Dental plans. This new edition provides the most comprehensive database of the rapidly changing managed healthcare industry on the market today, offering more consistency in state listings than ever before, as well as lists of major consolidations in the health insurance industry—ongoing since the introduction of the Affordable Care Act in 2010. This edition includes over 100 brand new entries.
In addition to detailed profiles of managed healthcare organizations, this 2020 edition of the Guide to U.S. HMOs and PPOs includes:
- A 27-page report on Health Insurance Coverage — National Health Interview Survey, 2018 — with charts, tables, and maps, including insurance trends and state comparisons.
- Small Area Health Insurance Estimates: 2017, twelve pages of maps, charts, and statistics from the U.S. Census Bureau
- State Statistics and Rankings section with state-by-state numbers of individuals covered by type of health plans, and state ranking by number of individuals enrolled in health plans.
In addition to new listings and updated profiles, users will find reflection of several large mergers in the health insurance industry. One is CVS acquiring Aetna; in the process, they sold their Aetna Medicare division to WellCare Health Plans. Another is Cigna combining with Express Scripts.
Plan profiles are arranged alphabetically by state. The first page of state chapter features a State Summary chart of Health Insurance Coverage Status and Type of Coverage by Age. This chart includes a number of categories, from "Covered by some type of health insurance" to "Not covered at any time during the year." Immediately following the State Summary, plan listings provide crucial contact information, including key executives, often with direct phone numbers, email addresses, fax numbers, websites, and more.
Each profile provides a detailed summary of the plan, including some of the following:
- Type of Plan, including Specialty and Benefits
- Type of Coverage
- Type of Payment Plan
- Subscriber Information
- Financial History
- Average Compensation Information
- Employer References
- Current Member Enrollment
- Hospital Affiliations
- Number of Primary Care and Specialty Physicians
- Federal Qualification Status
- For Profit Status
- Specialty Managed Care Partners
- Regional Business Coalitions
- Peer Review Information
- Accreditation Information
The plan profiles include key executives, fax numbers, websites, and email addresses.
In addition to the detailed front matter, state statistics, and comprehensive plan profiles, the Guide to U.S. HMOs
& PPOs includes two Appendices and five Indexes.
- Appendix A: Glossary of Health Insurance Terms—Includes more than 150 terms such as Aggregate
Indemnity, Diagnostic Related Groups, Non-participating Provider, and Waiting Period.
- Appendix B: Industry Web Sites—Contains dozens of the most valuable health care web sites and a
detailed description, from Alliance of Community Health Plans to National Society of Certified
Healthcare Business Consultants.
- Plan Index: Alphabetical list of insurance plans by seven plan types: HMO; PPO; HMO/PPO; Dental;
Vision; Medicare; and Multiple.
- Personnel Index: Alphabetical list of all executives listed, with their affiliated organization.
- Membership Enrollment Index: List of organizations by member enrollment.
- Primary Care Physician Index: List of organizations by their number of primary care physicians.
- Referral/Specialty Care Physician Index: List of organizations by their number of referral and
specialty care physicians.
The Guide to U.S. HMOs and PPOs is an invaluable resource for anyone within the healthcare industry, a much-used marketing tool for companies who provide materials and services to the managed care industry, and a useful reference for consumers seeking education and information about the world of managed care. This one-stop source has proven to be the premier guide in its field, containing an unprecedented amount of up-to-date information in a clear and easy-to-use format.
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