Key Findings¹

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• While medical loss ratio trends in commercial lines of business have largely met payer expectations, those in Medicare missed forecasts considerably. In response, payers are likely to increase premiums and/or cut benefits.
• Although the trend from 2017 to 2021 showed no significant change in the rate for cancer overall, rates for several types of cancer increased significantly—prostate cancer the most, at 3.3%.
• The Centers for Medicare and Medicaid Services has mandated collection of social determinants of health data for an increasing number of its programs. Although sparsely used, health equity—related Z codes remain foundational for both private and public population health investments.
• Artificial intelligence (AI) could help mitigate the rising national health expenditures. The use of AI diagnosis and treatment tools saved nearly $300,000 per day per hospital after 10 years in one study.

• Buoyed in part by four years of expanded premium subsidies for health insurance exchange (HIX) plans, overall private health insurance membership grew by 6.1% from 2020 to 2022 alone.
• HIX plan selection in Florida and Texas increased by 30.6% and 44.5%, respectively, in 2024, contributing to the nation surpassing the prior year’s enrollment total by 31.1%.
• Although improving slightly from 2023, overall HIX plan performance on eye exams for diabetes patients (44.9%) still lagged all other profiled metrics in 2024.
• Across the nation, nearly half (48.1%) of commercial Type 1 diabetes patients had an A1c >7.0%, with Wisconsin seeing the highest percentage of such patients, at 62.4% in 2023.

• Following a steady trend for over a decade, total Medicare enrollment reached another record high in 2023, with 66.4 million individuals enrolled in the program.
• Falling for the second year in a row in 2024, the top 10 largest Medicare Advantage (MA) organizations, by enrollment, earned an average overall rating of 3.7 stars—down from 3.9 in 2023 and 4.3 in 2022.
• Medicare fee-for-service actual costs increased from 2021 to 2022 for half of the settings shown. Such outpatient costs rose by 3.8% that year and by 12.0% the year prior.
• Total MA enrollment increased by 2.3 million from 2022 to 2023, with 52.2% of this growth generated by special needs plan membership—surpassing 50% for the first time.

• National Medicaid enrollment fell from a peak above 94 million (April 2023) to 85.5 million in December 2023, marking the first drop since before the COVID-19 public health emergency.
• Managed care penetration was reported to be over 75% for 41 states and Washington, D.C., in 2021— of those, 11 states reported 95% or more recipients covered through managed care plans for Medicaid.

• In recent months, overall employment in health care remained higher than the pre-pandemic level, bolstered largely by an increasing number of jobs in hospitals and clinics.
• The number of PAs was less than half that of NPs with a ratio of 0.49 nationwide in 2022. By state, Mississippi had the lowest ratio (0.07), while Alaska had the highest (0.85).
• In 2023, the Medicare average length of stay for the profiled disease states was highest for Type 2 diabetes (6.1 days)—notably 1.5 days longer than for Type 1 diabetes.
• Of the primary diagnoses shown, Type 1 diabetes cases had the highest Medicare 30-day hospital readmission rate in 2023 (32.0%), exceeding Type 2 diabetes by nearly 11 percentage points.

Key Findings1