US Health Insurance Growth Opportunities
Transitional Care Delivery Models and Payer Policies Redefining Stakeholders’ Future Growth Strategies
25-Apr-2022
North America
Market Research
K779-01-00-00-00
HC03535-NA-MT_26473
The United States is the world’s largest healthcare market, spending over 18% of its GDP on healthcare. Therefore, it is important for healthcare stakeholders to understand how the US healthcare market functions, primarily its insurance system. The US health insurance landscape has seen significant evolution through various legislations, ranging from the 1940s laws that established the Centers for Medicare and Medicaid Services (CMS) to the Affordable Care Act of 2010. More importantly, the insurance landscape has not been immune to the far-reaching impacts of the COVID-19 pandemic on how the payer community will operate in the future. The US healthcare landscape continues to evolve, leading to the growth of telehealth, virtual care, and home care models. These changes not only affect care delivery and reimbursement models in the United States, but also bring new opportunities for various stakeholders, including payers, home health agencies, and medtech companies. This study provides an overview of the US healthcare payer landscape and the emerging trends impacting this space, resulting in a slew of opportunities for growth in this evolving landscape.
Author: Siddharth Shah
Why Is It Increasingly Difficult to Grow?
The Strategic Imperative 8™
The Impact of the Top Three Strategic Imperatives on the US Health Insurance Industry
Growth Opportunities Fuel the Growth Pipeline Engine™
US Healthcare Payer Authority
2022 Payer Ecosystem
Important Regulations for US Healthcare Payers
Important Regulations for US Healthcare Payers (continued)
Medicaid Expansion (ACA)
Growth Drivers
Growth Restraints
Medicare
Standard Medicare vs Medicare Advantage (Medicare Part C)—2022
Medicare-Medicaid (Medi-Medi) Beneficiaries
Medicaid Overview
Medicaid Coverage
Medicaid for Long-Term Care
Commercial Health Insurance
Broad Trends and Technology Initiatives by Payers
Growth Opportunity 1—New Era of Portable and Smaller Medical Devices to Address Hospital at Home Demand
Growth Opportunity 1—New Era of Portable and Smaller Medical Devices to Address Hospital at Home Demand (continued)
Growth Opportunity 2—Home Health Agency Business to Evolve Patient Mix and Reimbursement in Response to Virtual Care Growth and PDGM
Growth Opportunity 2—Home Health Agency Business to Evolve Patient Mix and Reimbursement in Response to Virtual Care Growth and PDGM (continued)
Growth Opportunity 3—Hospital at Home a Major Growth Avenue for Care at Home Services, Payers, Healthcare Facilities, and Physician Groups
Growth Opportunity 3—Hospital at Home a Major Growth Avenue for Care at Home Services, Payers, Healthcare Facilities, and Physician Groups (continued)
List of Exhibits
Legal Disclaimer
- Health Insurance Landscape: Proportion of Population Insured by Type, United States, 2016
- Health Insurance Landscape: Regulations for Payers, United States, 1965–2012
- Health Insurance Landscape: Affordable Care Act Plans, United States, 2021
- Health Insurance Landscape: Status of Medicaid Expansion, United States, 2021
- Health Insurance Landscape: Growth Drivers, United States, 2022–2026
- Health Insurance Landscape: Growth Restraints, United States, 2022–2026
- Health Insurance Landscape: Health Insurance Coverage of Total Population, United States, 2019
- Health Insurance Landscape: Long-Term Care Spending by Source, United States, 2019
- Health Insurance Landscape: Medicaid Role in Long-Term Care for Seniors, United States, 2019
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