Markets at Risk— Current and Future Challenges in a Managed Care Marketplace. Trends in the Managed Care Sector


Several important trends in the managed care industry are explored and interpreted including:

  • Industry composition
  • Market structure
  • Product diversification
  • Provider networks
  • Care management practices

In general, a number of changes are evident in each of these areas. The industry has been transformed by a dramatic shift in ownership from not-for-profit to for-profit. Markets appear to becoming more concentrated with the influence of national plans more apparent. But achieving local market leverage continues to be a critical task for plans to accomplish in order to be successful. Product diversification is moving toward looser network products and also away from fully funded ones. Networks are growing in size in response to pressures to expand choice. Risk sharing between plans and providers has become extensive, but may now be reversing course as providers pushback on this and other fronts. Innovation in care management practices is apparent, but its widespread adoption faces many obstacles.