markets most likely to be disrupted by new care delivery ... · markets most likely to be disrupted...
TRANSCRIPT
Under Threat or Ready to Grow?
Analysis Reveals Markets Most Likely to Be Disrupted by New Care Delivery Models
Insight Driven Health
Many healthcare providers and payers have been examining market disruption through an outdated lens.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.
MARKET DISRUPTION INDEXLOW HIGH
Figure 2. Market Disruption Index by CBSAs
MARKET DISRUPTION INDEXLOW HIGH
Analysis reveals that approximately 21 percent of CBSAs (86 CBSAs that comprise more than 37 million people) are well positioned for providers to disrupt local care delivery models. Who made the list? These are the top 25 markets with a population base of more than 250,000 (See Figure 1):
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 (Figure 2).
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.
Common denominators for disruption
1. WILMINGTON, NC
2. SALEM, OR
3. GREELEY, CO
4. FAYETTEVILLE, NC
5. MERCED, CA
6. DURHAM-CHAPEL HILL, NC
7. HUNTSVILLE, AL
8. LAREDO, TX
9. EUGENE, OR
10. ASHEVILLE, NC
11. OLYMPIA-TUMWATER, WA
12. CLARKSVILLE, TN-KY
13. CAPE CORAL-FORT MYERS, FL
14. LUBBOCK, TX
15. READING, PA
16. NAPLES-IMMOKALEE- MARCO ISLAND, FL
17. LYNCHBURG, VA
18. BREMERTON-SILVERDALE, WA
19. COLLEGE STATION-BRYAN, TX
20. GREENSBORO-HIGH POINT, NC
21. WILMINGTON, DE-MD-NJ
22. WINSTON-SALEM, NC
23. BOISE CITY, ID
24. DES MOINES-WEST DES MOINES, IA
25. NEW HAVEN-MILFORD, CT
Figure 1. Top 25 CBSAs positioned for healthcare disruption.
Source: Accenture analysis
To see an interactive map of the top 50 markets, click here.
Figure 2. Market Disruption Index by CBSAs
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.
How to remain competitiveIndustry 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?
PAYERSPayers 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.
PROVIDERSMeanwhile, 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.
Weathering the stormDisruption is ubiquitous in healthcare. But that does not mean payers and provider have to sit on the sidelines and watch it happen. Those who can be the disruptors and build capabilities to deliver efficient care and maximize value-based payments will be well positioned for the future.
For more information:
Alan Nalle [email protected]
Geoffrey Hills [email protected]
Peter Gregory [email protected]
Methodology
Accenture analyzed current provider and payer market data and future consumer demand trends for the Medicare population, and mapped these to the top 407 CBSAs in the continental US. The dynamics reviewed in each market include population growth, market share, projections for outpatient procedures and population health trends. Data sources include Billians HealthDATA, Truven Health Analytics, and the Centers for Medicare and Medicaid Services.
About Accenture Insight Driven HealthInsight driven health is the foundation of more effective, efficient and affordable healthcare. That’s why the world’s leading healthcare providers and health plans choose Accenture for a wide range of insight driven health services that help them use knowledge in new ways—from the back office to the doctor’s office. Our committed professionals combine real-world experience, business and clinical insights and innovative technologies to deliver the power of insight driven health. For more information, visit: www.accenture.com/insightdrivenhealth.
About AccentureAccenture is a leading global professional services company, providing a broad range of services and solutions in strategy, consulting, digital, technology and operations. Combining unmatched experience and specialized skills across more than 40 industries and all business functions–underpinned by the world’s largest delivery network–Accenture works at the intersection of business and technology to help clients improve their performance and create sustainable value for their stakeholders. With approximately 384,000 people serving clients in more than 120 countries, Accenture drives innovation to improve the way the world works and lives. Visit us at www.accenture.com.
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