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What’s the Breakout of Small vs Large Health Insurance Plans?

Posted on October 31, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It never ceases to amaze me how our perceptions of how large something is can be skewed. It’s easy for us to see a really large company and assume that it must have the majority of the market share. This perception might be even more skewed because of companies like Google, Amazon, and Microsoft which really do have the majority of the market.

It’s a well-known idea in the tech startup world that the big winner will win the majority of the market, a second company will own most of the rest and then a long tail of others will have a small share and then eventually disappear. A great modern example of this is Uber followed by Lyft and then everyone else.

While this is an interesting way to look at a market when investing in tech companies, I’m surprised how often it doesn’t play out the same way in healthcare. The first time I saw this was in the lab market. Everyone knows that the 2 dominant players in the lab market are LabCorp and Quest. While they are both large companies, they still don’t have even close to a majority of the lab market. There are so many other independent labs and every hospital and health system has their own labs as well.

While looking at a recent report on the SMB Health Insurance Market by edifecs, I saw the same situation in the health insurance market. We all know about the massive health insurance companies that dominate the headlines. However, this report highlights the number of small and medium sized health plans out there. It was also interesting to note how these small plans are more concentrated in certain states.

If you don’t want to read the full report, this infographic summarizes a number of the stats and findings:

Is this result surprising to you? What does this mean for healthcare? Is there an opportunity for these small to medium size health plans to disrupt healthcare? Will we see more small plans chipping away at the large health plans?

ICD-10 Delay Finalized with New Unique Plan Identifier

Posted on August 24, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Another big week for healthcare IT and HHS. First, we got the meaningful use stage 2 final rule and now we have the official ICD-10 delay (See our previous post about the proposed ICD-10 delay). Here’s a quote from the announcement:

By delaying the compliance date of ICD-10 from Oct. 1, 2013 to Oct. 1, 2014, we are allowing more time for covered entities to prepare for the transition to ICD-10 and to conduct thorough testing.

This will be a welcome announcement for many in healthcare. Edifecs sent me the following comment about the delay which I think sums up most people’s feelings.

Edifecs commends HHS for finalizing its ruling on the ICD-10 one-year delay. We believe HHS has made the right decision and that a delay of this length strikes a fair compromise in meeting the needs of those healthcare entities that have already started down the ICD-10 path and those that have failed to either begin or show much progress. This one-year delay will give more time to those who need it and will also help those who were on track avoid the excessive costs an even longer delay would have created. Edifecs is encouraging its customers, and the entire healthcare industry, to continue moving forward with their ICD-10 implementations in order to meet the mandate ahead of schedule or on time.

That’s a pretty good word of caution. 2 years seems pretty far away, but that time will pass quickly.

Bigger news might even be the New national unique health plan identifier (HPID) that is being put in place. Sebelius explains, “These new standards are a part of our efforts to help providers and health plans spend less time filling out paperwork and more time seeing their patients.” I’ll be interested to learn more about this identifier and what insurance plans think of it.