Managed Care

Employer-sponsored insurance here to stay

Employer-sponsored health coverage will remain the dominant model of insurance, according to a study by IMS Payer Solutions. About 44 million more Americans will have health coverage by 2020, thanks to the Affordable Care Act — if it is found to be constitutional — and 25 million of them will be in insurance exchanges.

The study questions data, particularly those collected by the Medical Expenditure Panel Survey (MEPS), that have been interpreted to mean that private insurance might fade. IMS says that with limited access to private sector data, health services researchers have relied on analysis of public data to inform public policy recommendations, but to effectively advance health care reform a deeper understanding of the privately insured population will be critical to successfully addressing cost and growth trends.

To take just one example, IMS says that outpatient and inpatient services amount to 59 and 20 percent of total spending, respectively. The MEPS, which is sponsored by the Agency for Healthcare Research and Quality, says it’s 39 and 43 percent, respectively. The influx of patients into private insurance will mean that clinical executives will need to gain a better understanding of how members with cancer, chronic conditions, and autoimmune diseases — the high-cost members — use health care services.

Insurance enrollment in millions, real and projected

Insurance enrollment in millions, real and projected

Health care expenditures in billions, real and projected

Health care expenditures in billions, real and projected

Note: The IMS survey is based on a review claims for 10 million privately insured people under age 65 that took place between Jan. 1, 2009 and Dec. 31, 2010.

Source: “Healthcare Spending Among Privately Insured Individuals Under Age 65,” IMS Institute for Healthcare Informatics, February 2012

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