If medical billing and coding professionals do not already work for one of the three largest healthcare providers in the nation, chances are that at some point in their career they will cross paths with one. Collectively these companies account for nearly 30 percent of the market share of the healthcare industry in the United States: UnitedHealth Group, WellPoint, and Kaiser Permanente. The fourth-largest is Humana, which accounts for less than four percent of the healthcare industry.
The name of the game in the healthcare industry is subsidiaries, divisions, conglomerates, partnerships, and the like. Each of these healthcare companies owns, manages, or is in a partnership with hundreds of facilities where health and medical services are provided. Over the past several decades healthcare companies have become larger and larger. Smaller companies are swallowed up as this expansion takes place, in a consolidation process undertaken by companies to be able to face their competition, which is doing exactly the same thing.
Combine this process of consolidation with the rapidly-changing healthcare system and it spells potential turmoil for medical billing and coding professionals. The good news is that the healthcare industry is not a zero-sum game; as healthcare companies are expanding the overall healthcare market – largely fueled by the retiring baby-boomer generation – is also expanding, and this will more than make up for any billing and coding jobs lost due to company consolidations and mergers.
UnitedHealth Group generates over 11 percent of healthcare revenues in the country and covers roughly 70 million Americans. It is a publicly-traded company based in Minneapolis with approximately 133,000 employees.
UnitedHealth Group is organized to provide healthcare services in four primary categories and has operations in every state:
- Military and veterans programs
- Employer and individual programs
- Federal and state programs
- Medicare and other retirement programs
WellPoint is based in Indianapolis and earns close to 10 percent of the revenue created in the healthcare industry. 67 million Americans are covered under WellPoint plans and the company counts 47,500 employees. Significantly, WellPoint is the largest publicly-traded member (independent licensee) of the Blue Cross and Blue Shield Association.
Through the Blue Cross and Blue Shield Association WellPoint serves 14 states all or partially (California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia, and Wisconsin). It provides additional care through its UniCare subsidiary, as well as its CareMore program and Amerigroup company.
WellPoint is also a provider of Medicare coverage to 27 million Americans in five territories and 23 states.
Kaiser Permanente makes up more than seven percent of the nation’s healthcare market share, and provides coverage for over nine million Americans. Based in Oakland, Kaiser Permanente is the largest non-profit healthcare company in the United States and has nearly 240,000 employees.
Kaiser Permanente is structured as a partnership between different entities. These entities can be individual health care plans, physicians’ offices, hospitals, and other healthcare providers or plans. These entities are in turn grouped together by region and managed as such. Kaiser Permanente operates in eight regions throughout the country: Northern California, Southern California, Colorado, Georgia, Hawaii, Mid-Atlantic (parts of DC, Maryland, and Virginia), and Northwest (parts of Oregon and Washington).
|% of Healthcare Market|
|# of Covered|
|# of employees|
|Profits in 2013|