Which markets will
new healthcare delivery
Exploring market dynamics
Many healthcare providers and payers have been examining market disruption through an outdated lens. Nationwide and statewide dynamics are factors too broad to adequately signal the threat of disruption—or growth opportunities.
To better evaluate the health markets poised for potential growth or disruption in care delivery models, Accenture examined market dynamics across payers, providers and consumers among more than 400 Core Based Statistical Areas (CBSAs) in the continental United States.
Disruptive markets are characterized by a few providers with a strong market presence, or one dominant provider; fragmented payer competition; and increasing demand for outpatient services. These CBSAs are expecting strong growth, greater than 20 percent, for outpatient services in the next 10 years—and they are in an ideal position to manage a patient's health across the care continuum.
Providers located there should explore growth opportunities by tapping into their inpatient market share to expand population health. The leaders will extend their geographic reach or density servicing new patients, while simultaneously building a compelling in-house provider network.
These burgeoning markets also have the right dynamics for introducing disruptive business models, such as risk-based provider products that redefine the role of the payer. Some markets could even see the entry of additional provider-sponsored health plans.
Industry convergence is blurring the lines between providers and payers. Market share alone, or as a primary factor, does not insulate payers or providers from the threat of competing products or new market entrants or from the risk of overall regulatory compliance. So what should both groups do to help appropriately sustain—or strengthen—their market position while ensuring that any arrangements are in line with regulatory requirements?
Payers must compete at a hyper-local level to help foster loyalty. To do so, they need to invest in innovative products and programs that improve brand awareness at a local level. Options include exploring innovative partnerships and extending the definition of "providers" to include community resources, patient navigators and local nonprofits to improve health outside of the doctor’s office. Payers also can consider diverse models with providers to offer risk management services. By working in this way, the payer may diversify revenue while also managing its risk.
Meanwhile, providers can take advantage of their hyper-local market presence and consumer trust to help compete—and win—with much larger national plans. Investing resources to meet growing outpatient demand and acquiring new physicians allows providers to create a "preferred" network for members in their geography. Expanding the continuum of care opens up opportunities to support value-based payment models. Providers should gain newfound capability to track quality, measure outcomes and ultimately provide efficient, effective care that garners better reimbursement.