New York -Newark-Jersey City, NY-NJ-PA Metro
Miami-Fort Lauderdale-West Palm Beach, FL Metro
Phoenix-Mesa-Scottsdale, AZ Metro
Detroit-Warren-Dearborn, MI Metro
Tampa-St. Petersburg-Clearwater, FL Metro
Cincinnati, OH-KY-IN Metro
Charlotte-Concord-Gastonia,
NC-SC Metro
Los Angeles-Long Beach-Anaheim, CA Metro
Minneapolis-St. Paul-Bloomington, MN-WI Metro
Portland-Vancouver-Hillsboro, OR-WA Metro
San Francisco-Oakland-Hayward, CA Metro
Riverside-San Bernardino-Ontario, CA Metro
Pittsburgh, PA Metro
Providence-Warwick,
RI-MA Metro
PAYVIDER MARKET INDEX
San Jose-Sunnyvale-Santa Clara,
CA Metro
Seattle-Tacoma-Bellevue, WA Metro
Boise City, ID Metro
Des Moines-West Des Moines, IA Metro
Denver-Aurora-Lakewood, CO Metro
Salt Lake City, UT Metro
Hartford-West Hartford-East Hartford, CT Metro
Boston-Cambridge-Newton, MA-NH Metro
Atlanta-Sandy Springs-Roswell, GA Metro
Washington-Arlington-Alexandria, DC-VA-MD-WV Metro
Dallas-Fort Worth-Arlington, TX Metro
Chicago-Naperville-Elgin, IL-IN-WI Metro
Atlanta-Sandy Springs-Roswell, GA Metro
Philadelphia-Camden-Wilmington, PA-NJ-DE-MD Metro
Houston-The Woodlands-Sugar Land, TX Metro
Powered by the Guidehouse Center for Health Insights
The four quadrants shown below detail the extent to which market opportunities for payvider partnerships with upside growth potential exist. Click the bubbles to see the market names.
Look no further
than your mission statement as
a compelling
argument for why now is the time for a payvider strategy.
By uniting mission with fiduciary intent, organizations can more skillfully create
an engine of growth that supports sustainable margins and better health for all.
• How well can your organization anticipate consumer needs
and competitive disruption?
• What impact will payment disruption in your market have on
fee-for-service contracts?
• To what extent is your organization capable of responding to disruption in care delivery?
As payers increasingly demonstrate interest in shared-risk models, providers need to
know when it’s their time to make the move.
When to Make the Right Move
Markets Ripe for Payviders
What is a Payvider?
Contractual or joint ownership arrangements between payers and providers
These models have quickly become the preferred method to incentivize payers and providers that demonstrably improve member health outcomes and experiences at lower costs.
The rules of the game for delivering high-quality,
cost-effective, consumer-centric care are changing,
and payers and providers that don’t adapt their business models will be left behind.
Now is the Time for Payvider Adoption & Growth
Most providers and payers have two choices:
1. Maintain the status quo
2. Develop and grow payvider models to strengthen the ability to compete and improve margin
Is it Time to Upgrade Your
Business Model?
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Download the Full Report
PAYERS
Providers
Learn more
Learn more
Providers
PAYERS
See the Top 10 Markets
See the Top 10 Markets
Please view desktop for full animation or download the full report.
Download the Full Report
Download the Full Report
Download the Full Report
Download the Full Report
The Guidehouse Center for Health Insights identified markets where payvider models are best positioned to disrupt incumbent hospitals, health systems, and health plans. The analysis is based on projected growth in health plan membership under capitated payment arrangements, relative to current utilization, cost, and quality performance.
QUADRANT 4
VALIDATE VALUE-BASED INVESTMENTS GIVEN MARKET
COMPETITIVENESS AND MORE MODEST GROWTH POTENTIAL
QUADRANT 1
DOUBLE DOWN ON VALUE-BASED PAYMENT
AND DELIVERY STRATEGIES
QUADRANT 2
LEVERAGE EXISTING VALUE-BASED
ENTITIES WITHIN EXISTING MARKETS
QUADRANT 3
EXPAND EXISTING VALUE-BASED ENTITIES
INTO NEW, HIGHER GROWTH MARKETS
Providers
PAYERS
Providers
Most markets will require value-based models to sustain margin.
Commercial payers will continue to follow CMS’s lead for alternative payment models, particularly in increasing geographies.
•
•
Payers
CMS will increasingly narrow value-based payment models to those that save Medicare money and are scalable to large populations, with a shift from voluntary to mandatory adoption.
There could be a push to achieve payment parity between Medicare Advantage and Medicare by moving the Medicare Advantage base provider reimbursement rate to 95% of Medicare fee for service, with the ability to earn back up to 100% of Medicare reimbursement through improved performance.
•
•
Growth in specialty-specific payviders (oncology, nephrology, etc.) will create risk for providers, losing access to lives or lucrative parts of their business if they don’t find ways to align and partner.
•
Commercial payers and employers that are willing to replace traditional fee-for-service payments with more rewarding PMPM payments in return for delivering on the Triple Aim will be attractive partners.
•
Get in Touch
Get in Touch