10 states with the least competitive PPO markets
Published September 24, 2015 4:37 PM
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Updated September 25, 2015 3:04 PM
1 Min Read
Overview:
Health insurance industry insiders fear merger and acquisition activity is eroding market competition, a trend that could lead to increased premiums for employers and individuals. Recent research from the American Medical Association identified the top 10 states with the least competitive PPO markets based on market concentration levels as determined by the HerfindahlHirschman Index or HHIa measure used by the U.S. Department of Justice and the Federal Trade Commission.
The HHI number can range from close to zero to 10,000. DOJ considers a market with a result of less than 1,000 to be a competitive marketplace; a result of 1,000-1,800 to be a moderately concentrated marketplace; and a result of 1,800 or greater to be a highly concentrated marketplace.
The HHI number can range from close to zero to 10,000. DOJ considers a market with a result of less than 1,000 to be a competitive marketplace; a result of 1,000-1,800 to be a moderately concentrated marketplace; and a result of 1,800 or greater to be a highly concentrated marketplace.
10) Hawaii
PPO HHI: 5,799
PPO with the largest market share: HMSA (Blue Cross Blue Shield HI) with 75%
PPO with the second largest market share: University Health Alliance with 11%
PPO with the largest market share: HMSA (Blue Cross Blue Shield HI) with 75%
PPO with the second largest market share: University Health Alliance with 11%
9) Tennessee
PPO HHI: 5,812
PPO with the largest market share: Blue Cross Blue Shield TN with 75%
PPO with the second largest market share: Aetna with 12%
PPO with the largest market share: Blue Cross Blue Shield TN with 75%
PPO with the second largest market share: Aetna with 12%
8) Nebraska
PPO HHI: 5,841
PPO with the largest market share: Blue Cross Blue Shield NE with 74%
PPO with the second largest market share: Aetna with 19%
PPO with the largest market share: Blue Cross Blue Shield NE with 74%
PPO with the second largest market share: Aetna with 19%
7) Delaware
PPO HHI: 6,095
PPO with the largest market share: Highmark with 75%
PPO with the second largest market share: Aetna with 21%
PPO with the largest market share: Highmark with 75%
PPO with the second largest market share: Aetna with 21%
6) North Carolina
PPO HHI: 6,128
PPO with the largest market share: Blue Cross Blue Shield NC 77%
PPO with the second largest market share: Aetna with 14%
PPO with the largest market share: Blue Cross Blue Shield NC 77%
PPO with the second largest market share: Aetna with 14%
5) Louisiana
PPO HHI: 6,189
PPO with the largest market share: Louisiana Health Services & Indemnity (BCBS) with 78%
PPO with the second largest market share: Aetna with 9%
PPO with the largest market share: Louisiana Health Services & Indemnity (BCBS) with 78%
PPO with the second largest market share: Aetna with 9%
4) Iowa
PPO HHI: 6,338
PPO with the largest market share: Wellmark (BCBS) with 78%
PPO with the second largest market share: Aetna with 13%
PPO with the largest market share: Wellmark (BCBS) with 78%
PPO with the second largest market share: Aetna with 13%
3) Michigan
PPO HHI: 6,681
PPO with the largest market share: Blue Cross Blue Shield MI with 81%
PPO with the second largest market share: Aetna with 6%
PPO with the largest market share: Blue Cross Blue Shield MI with 81%
PPO with the second largest market share: Aetna with 6%
2) South Carolina
PPO HHI: 6,775
PPO with the largest market share: Blue Cross Blue Shield SC with 82%
PPO with the second largest market share: Aetna with 9%
PPO with the largest market share: Blue Cross Blue Shield SC with 82%
PPO with the second largest market share: Aetna with 9%
1) Alabama
PPO HHI: 8,737
PPO with the largest market share: Blue Cross Blue Shield AL with 93%
PPO with the second largest market share: Aetna with 3%
PPO with the largest market share: Blue Cross Blue Shield AL with 93%
PPO with the second largest market share: Aetna with 3%
