Alaska has no HMOs. Who knew? Well, you will after you read this chapter on health insurance and managed care, which includes several exhaustive lists on those topics.
For example, Massachusetts has the highest HMO penetration rate of any state, at 54.2%, according to 1997 data, the latest available from InterStudy, a Bloomington, Minn.-based managed-care research organization. Further down the list is the managed-care laboratory called Minnesota, at 32.4%.
Even further down the list is Vermont, whose HMO penetration is so low, it registered as 0.0% on InterStudy's list.
Nationwide, the average is 28.6%, meaning that fewer than one in three people receive their health insurance benefits from an HMO.
Yet, the managed-care industry is the one segment of the healthcare industry that virtually everyone loves to hate. Most hospitals and physicians blame managed care for whatever financial ills they claim to be suffering. And many consumers blame managed care for everything from inaccessible health services to inexplicable claims processing.
In reaction, a number of states are passing "patient protection" bills to safeguard consumers' rights in dealing with managed-care plans. Federal legislation that aims to do the same thing is now in its second year of debate. The fear of state and federal regulation has prompted many national health plans to expand the appeal rights of their enrollees.
Providers are pushing legislation of a different kind: State laws that would require managed-care plans to pay hospitals and physicians in a reasonable amount of time. Twenty-six states now require health insurers to pay clean claims within a specified period. Of those states, seven adopted prompt-pay legislation this year.
Those states are Florida, Nevada, North Carolina, Pennsylvania, Vermont (despite having virtually no HMO penetration), Virginia and Wisconsin.
As a provider or a consumer, where do you register your complaints? Your state insurance department. This chapter of By the Numbers lists the health insurance commissioners in each state and their phone numbers.
* The nation's largest managed-care plans as measured by total enrollment.
* A state-by-state listing of Blue Cross and Blue Shield plans.
* The largest managed-care mergers and acquisitions as measured by the dollar amount of the transaction.
* And a list of states that have received federal waivers to adopt managed-care-based systems for their Medicaid programs.