The makeup of these two factors then impacts
how each provider organization interacts with
payers in the space.
With appropriate insights into one’s market,
health systems can effectively control technology fragmentation, leverage payer relationships,
and react to competition.
EHR Chaos Defined
While a handful of major players dominate large
health system deals, the EHR space remains
fragmented in many geographies, particularly
outside of acute care settings. As a result,
many healthcare entities continue to struggle
to capture, share, and use data from numerous
disparate EHR systems.
The average health system is managing 18
different EHR vendors, 2 and more than half of
hospital network physician practices feel like
they can’t take advantage of value-based care
reimbursements due to limited interoperability
capabilities. 3 These challenges don’t end with
small organizations. Even the largest health
systems inevitably reach a point where they
must integrate data from outside their system,
including from independent physician practices,
retail health centers, post-acute centers, ancillary providers, and others.
Thus, health systems may encounter either:
F High EHR chaos—indicating that an organization is working with multiple vendors and may
have challenges tied to data aggregation, meaning normalization could be a major challenge.
F Low EHR chaos—indicating that an organization may have one vendor that controls most
of the market. However, this doesn’t mean
issues of interoperability, data collection, and
analysis are absent.
As healthcare organizations seek to improve
their population management, knowing which
IT systems need to be integrated and how to do
this effectively to provide a holistic picture of
patient care is essential to creating a foundation
for any program.
Competition Chaos Defined
The pace of hospital consolidation has quickened
in recent years—nearly half of hospital markets
in the United States are now highly concentrated,
and many areas of the country are dominated by
one or two large hospital systems. 4 While large
systems can have greater influence than small
ones, they also may be less nimble in responding
to market shifts.
Non-traditional competition has grown, too. In
a dynamic market where demanding consumers
seek new methods and settings of care delivery,
transparency, and competitive costs, health
systems are now facing retail clinics, outpatient
urgent care centers, and even tech giants like
Amazon and Apple in an already crowded space.
These new healthcare delivery models often
deliver low-cost convenience, competing with
care formerly provided in an emergency department (ED) or physician’s office—potentially
channeling patients to competitors (see “
Having an understanding of the competitive
environment around a healthcare organization
helps ensure that the provider’s population health
efforts meet the needs of its unique population.
Payer Breakdown Chaos Defined
Today’s payer market is seeing a consolidation
of payers, vertical integration, new payment
models, and a growing number of consumers
Payer breakdowns also vary not only at the
state level but also by localized regions based
on the population and socio-economic landscape—adding further complexity. In California,
for example, Los Angeles has a high mix of
Medicaid and commercial insurers compared to
San Francisco, which has a largely commercial
payer base. 5
F High payer breakdown. Many commercial
payers are fighting for market share. This
may make developing a cohesive payer
strategy difficult, as payer push toward
value-based contracting may be uneven.
If your group finds itself with:
X High competition chaos. Fight hard
to attract patients and capture
value-based revenue ahead of the
X Low competition chaos. You have
opportunities to capture new
patients and revenue, but any
growth plans require a thorough
knowledge of competitors in surrounding market areas.