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Key Findings:

• Moderately competitive health plan market. The region’s leading health plan, CareFirst BlueCross BlueShield, is dominant in the small-group and nongroup (individual) segments. Three national insurers—UnitedHealth Group, Aetna, and Cigna—compete strongly in the large-group segment. Kaiser Permanente, an integrated delivery system with a closed, limited-provider network, has market share in the high-single digits but may be poised to grow.
• Complex hospital market with multiple overlapping submarkets. The hospital sector is characterized by significant geographic segmentation, especially between northern Virginia—where Inova Health System is dominant—and the rest of the region. Geographic boundaries are more porous between the District and Maryland. Besides Inova, the only other system with a major regional presence is MedStar Health. The major hospitals are all expanding their ambulatory care networks, with head-to-head competition especially heating up in affluent and fast-growing northern Virginia communities.
• Increased physician consolidation, though small, independent practices persist. The physician market has undergone substantial consolidation during the past decade, with hospital-owned groups and two large physician-owned groups recruiting aggressively and growing dramatically. Still, many physicians remain in small, independent practice, with a small but noticeable subset of physicians in the most affluent submarkets choosing some form of concierge medicine. For the much larger number of private-practice primary care physicians not taking the concierge route, participating in CareFirst’s patient-centered medical home program has made remaining independent more viable.
• Safety net generally strong but lacks cohesion. Overall, the region has a broad array of safety-net providers, including numerous large community health centers focusing on primary care for low-income people. The region has no dedicated safety-net hospital; much low-income inpatient care is provided by mainstream hospitals that play a significant safety-net role because of their location, size, and/or range of services. Despite strong safety-net providers and programs, the region lacks significant collaboration among safety-net organizations and between those organizations and local governments.