Live Webinar | Value-Based Payment
<div>The shift to value-based care has accentuated the need to enhance collaboration, and interoperability is a key element of seamless data sharing. The dual challenges of data standardization and easy information access are compromising t...
Save
On Demand Webinar | Intermediate | Value-Based Payment
The shift to value-based care has accentuated the need to enhance collaboration, and interoperability is a key element of seamless data sharing. The dual challenges of data standardization and easy information access are compromising the ab...
Save
Tools & Tips | Value-Based Payment

Assessing Your Situation – Market Assessment

Sponsored by Value Project Phase 3
Value Project Phase 3
Sponsored by
Tools & Tips | Value-Based Payment

Assessing Your Situation – Market Assessment

The next step is to take a close look at the market or markets in which your organization operates. What communities and populations does it serve? How much competition is there among provider organizations? Who are the major payers in your market?

The next step is to take a close look at the market or markets in which your organization operates. What communities and populations does it serve? How much competition is there among provider organizations? Who are the major payers in your market?

Market Area

  • What is the demographic makeup of your patient population? How is this likely to change in the future, and what are the implications for your organization?
  • How well does your organization understand community needs at a sub-population level? What are the sub-populations, and what challenges and opportunities do they present for your organizations?
  • How do you predict that the needs of the populations you serve will change in the future? How well do you think your organization can adapt to meet these needs?

Provider Market

  • What is the competitive landscape in your market area? How is it changing, and what are the drivers of these changes? What are the potential implications of changes among/by competitors for your organization?
  • Which organizations among your competitors are real threats? Why?
  • Which organizations among your competitors represent potential partners? Why?

Payer and Purchaser Market

  • Does a single payer dominate your market or is there competition among payers?
  • How aggressively are payers moving toward value-based reimbursement?
  • How are payers determining with which providers to partner on new payment methods, population health infrastructure, limited networks, etc.? Is your organization a potential partner, or is it excluded from these discussions? What would make it a more attractive partner?
  • How prevalent are provider-owned plans in your market? What is the potential for new provider-owned plans to develop?
  • How influential is the employer purchasing community in your market? What demands and expectations do they have of providers, and how are these changing?
  • What impact, if any, have insurance exchanges and limited network plans had? What is the potential, and what are the possible implications for your organization?

Reflecting on your answers

After reviewing the answers to your organizational and market assessment, how would you answer the following questions?

  • How will your organization fare in an environment of both fee-for-service and value-based payment in its current state? Would it fare better if it pursued some form of acquisition or affiliation?
  • How much effort and investment lies ahead to prepare for population health management, which is required under most value-based payment mechanisms? Is your organization equipped to dedicate the needed effort and capital, or will it need additional resources?
  • Is your organization’s strongest position for negotiating participation in an acquisition or affiliation model now or later?
Go to Next Page                                               Home
    
                               

Advertisements

Related Articles | Value-Based Payment

Blog | Value-Based Payment

Medicare Advantage concepts come to Medicare fee-for-service with Geographic Direct Contracting Model

While the MA Stars Rating program is a bonus program where plans can earn additional revenue for achieving high scores, quality in the Geographic Direct Contracting program is treated more like a penalty, says HFMA's Chad Mulvany.

Blog | Coronavirus

CMS waiver for hospital-at-home designed to address COVID-19-driven capacity issues

While it’s been rumored that the Center for Medicare & Medicaid Innovation was working on a hospital-at-home model, this is a short-term waiver designed to address COVID-19-driven capacity issues, said HFMA’s Chad Mulvany.

News | Coronavirus

Patient visit restrictions bringing many new costs

Ongoing hospital visitor restrictions can have a range of adverse effects, potentially affecting clinical outcomes and increasing costs for health plans and providers in value-based payment models.

Blog | Payment Models

Connecticut’s launch of a bundled payment program for its employee health plan is part of an effort to save the state $185 million

HFMA’s Chad Mulvany says some state governments, like Connecticut, have high enough volumes that COVID-19 may accelerate their adoption of value-based payment models.