knowing your market and your competition: steps for success kenneth t. hertz, facmpe independent...

Knowing Your Market and Your Competition: Steps for Success

Kenneth T. Hertz, FACMPEIndependent Consultant

MGMA Health Care Consulting GroupMGMA-ACMPE Annual Conference

October 6, 2013

All Markets are local

How is The Choice made?

Word of Mouth

Family Support

Transportation

Follow up care

Ancillary Services

Consumer reviews

© 2013 MGMA Health Care Consulting Group. All rights reserved.

Payer market concept for providers

Product for saleNo providers. No product

Network for membersBuy servicesBuy time

Quality and cost efficiency for buyersEmployers = Ultimate consumer


Strategic Plan for your local market

Local costs

Local politics

Local plan purchasers

Local resources

National plan purchasersInternational plan purchasers


How do you assess the current market characteristics?

Walk around in the other guys’ shoes

What does the payer want for their customer?

How can you provide for the member population?

How well and efficiently can you take care of their employees?


Who do the payers serve?

Member/Employees demographics

ScreeningTreatment

Health


How do you fit in their strategic plan?

Cost

Access

Quality

Efficiency

Reporting


What do they want from you?

.

Individual Patients

Patient Population

Episode Management

Administration


How do you distinguish yourself?

Payer Recognition Program

Range of Services

EfficiencyTo treatment resultsCost

Relationship with Provider Representative


Do you know the characteristics of your competition?

From the Payer Network Panel

Primary Care

Outpatient

Hospitalists

Clinical diagnosis


Who is like you on the payer panel?

Other Gastroenterologists

Check healthgrades scores www.healthgrades.com

Areas of vulnerabilityAccessBedside mannerPractice operations


http://www.healthgrades.com/

Do the other GI docs….

Distinguish themselves in the payer/quality recognition programs?

Offer a more robust/different range of services?

Administer the payer process efficiently?

Have a good demographic location?

Serve the members/employees better?


Who needs to know how/what you do?

The payer-directory listing

Primary Care panelCardiology panelGynecology panelPulmonary panel

Physicians new to the area/panel


What are the characteristics of competition?

Volume fluctuation

Change in:scheduling patterns demographicsreferral patternspayer mixcash flow


Local characteristics of competition

Word of mouthDoctor’s loungeLocal employers Employer associationsInsurance brokersLocal plansPayer hospital associationsHealth fairsCharity events


Using payer resources to assess competition

Payer panel listingSteerageUtilization Review CommitteeQuality Reports Episode of care feedbackCost unfiltered clinical guidelines

Evidence-based medicine

Data…data…data


How do you add value?

Quality + Cost = Value

AccessibleAffableAffordable

Population HealthThink from who pays the premiums


You serve who the payer serves…

Members = patients

Employers = consumers

Payers = project manager

Provider Panel = Team


Payer creates competition within the team

To provide efficient costs to consumer

Disadvantage competition costs not knownpayer knows local market costspossible steerage


Payer created competition….if you are good

AdvantageMethod to distinguish yourself in recognition programsSteerageFee differentialLocal relationships and referral patternsSponsored screening events


How do you add value to compete?

Quality + Cost = ValueAccessibleAffableAffordable

Population HealthThink from who pays the premiums

Clinical QualityQuality of the Patient ExperienceQuality of Outcomes


Questions?

[email protected]

knowing your market and your competition: steps for success kenneth t. hertz, facmpe independent...

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