"As we have emerged from the recession, technically you would have expected volumes to at least stabilize, because during the recession part of the volume decline was related to higher co-pays and higher deductibles," she said.
"While that may be still the same reason, it is because employers are fundamentally changing their commitment levels to providing healthcare insurance. Some of that early evidences of that are what you are starting to hear about in terms of employers turning to private exchanges. It is still very early on, but that is an example of an underlying shift in the industry. While caused by a number of issues, it is more of a fundamental change in the industry than a temporary one."
With three quarters in the books, Martin says 2013 is meeting predictions that it would be a "difficult year for the industry as a whole."
"Once we get the numbers for the whole year, our expectation is that volumes are down, obviously, and revenue growth rate is going to be down. We are expecting to see margins decline," she says.