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0:00
Hello. I'm Keith Kelly and I'm
happy to talk to you about
the US payer landscape on
behalf of Henry Stewart Talks.
0:09
The term payer is the title
of the talk and is
itself confusing.
It can be used to
refer to a variety of
US healthcare
industry stakeholders
who determine patient
access to therapies.
It's used to apply to
these different stakeholders
the term payer.
This slide has the funders.
These are the sources of
payment for insurance coverage.
What's important to
note here is that
roughly 50% of your coverage
comes from commercial
insurance providers,
these are your MCOs and
your payer-like IDNs,
and about half of it comes
from government sources like
the Center for Medicare and
Medicaid Services as
well as the VA and DoD.
0:53
This slide covers Managed
Care Organizations.
These are the organizations
that administer
health plans and
the five largest
of these organizations represent
more than 40% of
the 314 million covered
lives in the United States.
What has happened in the
last 10 years is that
there's been tremendous
consolidation among
the Managed Care
Organizations arriving at
that greater than 40% represented
in the top five figure.
Here are the top five
US health insurers.
They are United Health Group,
Elevance Health, Aetna,
Cigna and Humana.
What has changed in terms of
accessing these payers if
you're bringing a product
or a technology to them is
that, historically because
the US Healthcare
System was fragmented,
you could afford to win some
payers and lose some payers.
Now with these payers having
so many covered lives
within their benefits,
you really have to try to
reach each and every one of
these payers and have them
approve or decide to
reimburse your technology.
Let's talk about the other
half of US enrollment in