In the U.S. , HMOs are an example of integration between provider and payer. About 12 percent of those enrolled in employer-sponsored insurance are enrolled in HMOS https://www.kff.org/report-section/ehbs-2022-summary-of-findings/. However this percentage varies across payers. For example in 2020 about 72 percent of Medicaid recipients were enrolled in risk based managed care https://www.kff.org/other/state-indicator/total-medicaid-mco-enrollment/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. About 48 percent of Medicare recipients are enrolled in Medicare Advantage plans. Medicaid and Medicare managed care enrollment includes HMOs but also includes other forms of managed care such as preferred provider organizations