practices in a
mean it shouldn’t
While the lack of a strong payer may provide some pricing relief, managing differing
contractual relationships and data idiosyncrasies of each payer add to revenue
complexity and collections processes and
makes marching forward quickly with any
new contracting strategy challenging.
F Low payer breakdown. A single commercial
payer may control much of a market. Due to
the consolidated payer market, staying aligned
with significant payer strategies is essential
to maintain a competitive edge and a strong
negotiating position for favorable, broad contracts. These dominant payers are calling the
shots and may develop tiered and narrow networks to steer patients to low-cost, efficient
providers, keeping the provider market highly
dependent on its actions.
With these insights pulled together in one
place, health systems launching and operating population health programs will begin
to understand the level of complexity in their
market’s EHR landscape, payer breakdown, and
competitiveness—helping them understand the
conditions and determine strategies for operating a successful program.
Programs in rural and urban settings each face
both opportunities and challenges. To understand
how these are manifest in real markets, two communities in New York State highlight what these
landscapes mean to providers and how they
impact population health efforts.
Data disparity in Rural Oneonta
The rural community of Oneonta, a town in
central New York with a population of approximately 14,000, is one example of a market where
providers face low competition and EHR chaos,
but high payer breakdowns.
Just because a provider practices in a less
competitive market doesn’t mean it shouldn’t
be proactive. These providers should lead the
charge to deliver high value to health consumers in the market and be prepared for a broad
range of potential retail-based competitors.
Markets with low competition typically correlate
with high prices, which can cause alternate
consumer-friendly options to take root and gain
market share. Retail-like access and convenience
help ensure patients remain with the provider.
Because providers aren’t as worried about
patient retention in a less competitive market,
it’s also important to embrace risk. Markets are
beginning to punish overuse of the health system. So, those providers that take on the biggest
risk can find financial stability in the quality of
care they deliver. Starting with simple strategies
that close gaps in care and target high-utilizer
populations in ways that reduce financial risk
will bring the practice and experience needed
to learn successful risk strategies.
From an EHR perspective, providers in Oneonta are working with one primary vendor. Just
because one platform dominates the market,
however, doesn’t mean providers are able to