Tools & Tips | Value-Based Payment

Market Assessment

Sponsored by Value Project: Physician Engagement & Alignment
Value Project: Physician Engagement & Alignment
Tools & Tips | Value-Based Payment

Market Assessment

Both health systems and medical groups should assess and understand the local physician market to determine their best options. Ten questions for assessing a local physician market are:  What is the physician supply/demand balance in the market by specialty? What types of care are delivered within the market, and what is referred out of the market? Where do cases that leave the market go, and why? What are the referral patterns within the market? For example, do referrals go freely across system lines, or is “leakage” being reduced?  Are referrals influenced by narrow networks, clinically integrated networks, or some groups (for contractual reasons or other factors) not accepting some payer categories? Are some groups deemed to be of higher quality than others? What is the growth or decline in the patient population? How are patient demographics changing? How are physician groups likely to respond to the changes? Are physicians in some groups doing significantly better or worse financially than the market as a whole? How easy is it to recruit physicians to this market? Where does the market stand now in terms of these indicators:         •Medicare cost per member per month?         •Commercial costs per member per month?         •Physician group revenues per RVU, per specialty compared to national benchmarks?      

Both health systems and medical groups should assess and understand the local physician market to determine their best options. Ten questions for assessing a local physician market are:

  1. What is the physician supply/demand balance in the market by specialty?
  2. What types of care are delivered within the market, and what is referred out of the market?
  3. Where do cases that leave the market go, and why?
  4. What are the referral patterns within the market? For example, do referrals go freely across system lines, or is “leakage” being reduced? 
  5. Are referrals influenced by narrow networks, clinically integrated networks, or some groups (for contractual reasons or other factors) not accepting some payer categories?
  6. Are some groups deemed to be of higher quality than others?
  7. What is the growth or decline in the patient population? How are patient demographics changing? How are physician groups likely to respond to the changes?
  8. Are physicians in some groups doing significantly better or worse financially than the market as a whole?
  9. How easy is it to recruit physicians to this market?
  10. Where does the market stand now in terms of these indicators:
  • Medicare cost per member per month?
  • Commercial costs per member per month?
  • Physician group revenues per RVU, per specialty compared to national benchmarks? 

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