Surviving in a payor-dominated market
Abstract: In its 2007 study, Competition in Health Insurance: A Comprehensive Study of U.S. Markets, the AMA states that, in the majority of metropolitan statistical areas (MSAs), a single health insurer dominates the market. Indeed, their data shows that, in 64% of the 313 MSAs, one health carrier controls half or more of the business in HMO and PPO underwriting. This article explains what this payor dominance means for physician practices and offers some ways practices can fight back. A sidebar discusses some of the drawbacks of larger physician groups.