While the consolidation has been good for some, market trends have also conflicted with the political and market preferences of Minnesotans over the years.
Take the insurer market. The Twin Cities is home to one of the country's largest national insurers, UnitedHealthcare, yet the company effectively cannot operate in Minnesota because of a state law that prohibits for-profit HMOs from insuring people in the state.
“Even though UnitedHealthcare is based here, they don't sell a single health plan in the state of Minnesota because they are an investor-owned, for-profit business,” Massa says.
Still, healthcare market analyst Allan Baumgarten noted that UnitedHealthcare provides the administrative support for one of the market's three largest payers, Medica. The two other largest insurers in the state are Blue Cross and Blue Shield of Minnesota, and HealthPartners.
“There is a lot of activity going on here, and there is a lot of leadership in the purchaser community. I would say more than you see in most other markets,” Baumgarten says.
He noted that the Twin Cities tends to be a relatively expensive market, and there are some reasons to think that the heavily consolidated provider market has been using its leverage to shift Medicare losses onto the private payers.