The Market

Health Insurance Coverage

While everyone seems to agree that health insurance is a big problem–that most practices/providers hate dealing with–the facts about health insurance coverage reveal why practices may struggle if they don’t try to offer some benefit for patients with health insurance.

  • Health Insurance Demographics (Click Here)
    • 10% of Americans have no insurance.
    • 30% of Americans are Medicare/Medicaid/Tricare.
      • 7.5% Traditional Medicare
      • 7.5% Medicare Advantage
      • 15% Medicaid
    • 60% of Americans have private plans.
      • 35% Employer-based plans non-HMO
      • 15% Employer-based plans HMO
      • 7% of private individual plans non-HMO
      • 3% of private individual plans HMO
    • Target populations for private practices.
      • 90% of Americans have some form of insurance.
      • Most affluent groups are traditional Medicare and individual non-HMO plans (14.5%)
      • Remaining 85.5% (no insurance, Medicaid and employer plans) may not be a good fit.

Articles

  • “BIG INSURANCE 2022: Revenues reached $1.25 trillion thanks to sucking billions out of the pharmacy supply chain – and taxpayers’ pockets,” Wendell Potter. Health Care un-covered, February 27, 2023 (Click Here).
  • Walgreens closes primary care.
  • Walmart closes primary care.
  • Humana exits employer based plans.

e3Business Articles

  • The Elephant and I&FM: A Parable (CLICK HERE)
    • One of the problem with integrative, holistic and functional medicine is that there is not a generally accepted definition of integrative, holistic and functional medicine–or what it looks like.
  • “Rise, Crash and Burn: Looking Back at a Las Vegas Medical Group Launch and the Lessons Learned,”  e3Business Article (CLICK HERE)
    • A case study in the launch, management and failure of a concierge practice.
  • “Direct Primary Care Goes Thud,” e3Business Article (CLICK HERE)
    • Three examples of Direct Primary Care that were not successful.
  • “Making Money with Functional Medicine,” e3Business Article (CLICK HERE)
    • For years, people have been talking about how functional medicine is going to very lucrative, but that isn’t necessary the case.
  • Failure to Launch (CLICK HERE)
    • What are the market forces that have suppressed I&FM practices?
  • “Functional Medicine Data Fallacies,” e3Business Article (CLICK HERE)
    • We have access to more data than ever before, but not all of it means what we think it does.
  • “The Source of Provider Compensation,” e3Business Article (CLICK HERE)
    • Are cash-pay providers really that much of an outlier?
  • “There’s a New Sheriff with an IFM Digital Badge,” e3Business Article (CLICK HERE)
    • The Institute for Functional Medicine’s new certification change including enforcement powers is a big, big change for functional medicine providers.

IFM Data

Since 2016, e3Business has periodically tracked the changes of the physicians listed on the Find a Provider page of The Institute for Functional Medicine (IFM).

Archived Case Studies and Competition

This area is no longer updated on a regular basis, but provides information on current and former integrative, holistic and functional medicine practices.