Organizations in today’s health care marketplace are faced with crucial business decisions. On the one hand, rapid developments in key local markets are changing how health-related companies and professionals will organize and operate their businesses or practices in the future. At the same time, implementation of national reform initiatives at the state level will create significant opportunities and challenges. And it will also rewrite the rules under which insurers, providers and manufacturers and vendors of health products and services will do business.
To make the right business decisions, these organizations need timely, high quality information. They are asking:
How will market changes and health reform initiatives affect my volume of patients or customers and how I get paid?
Whom do I compete with and what are those competitors doing? For example, health insurers are examining their product design and networks to see if they are positioned to sell to small groups an individuals through the new health insurance exchanges and other channels.
Should I form an Accountable Care Organization or join some other kind of integrated delivery system? How should I choose partners?
Like politics, health care is local. Providers and insurers are trying to decide if and how they should compete in certain local markets. They are asking:
How does their market share compare with their competitors? What is the cost structure of competing organizations?
How will decisions by health care purchasers affect how providers and health plans deal with each other? How receptive are providers and employers to new entrants in the market?
What will payment reform mean to providers and health insurers? ACOs are only one approach to changing the incentives that reward providers based on volume and not on quality or outcomes.
Manufacturers and vendors of drugs, devices and services are trying to understand how changes in the ways providers are organized and paid affect how they market their products. For example, they need to know whether the decision to use one product or procedure over another will be made by an HMO, an employer, an integrated provider network or an individual practitioner. What will drive those purchasing decisions–measured outcomes? Price alone? How will the growth of HMO Medicaid and Medicare enrollment affect them?
Here are examples of the projects that I’ve completed since launching my practice in November 1993:
Local market consultations. I consult with several pharmaceutical manufacturers on strategies in local markets and make presentations to their representatives and managers. I have provided consultations on the Minnesota market and markets in other states to provider groups, national foundations and to other consultants, including PWC, Buck Consultants, the Wilkerson Group, the Advisory Board, the Urban Institute and Center for Studying Health System Change. In 2015 I prepared a report for the Robert Wood Johnson Foundation analyzing provider strategies of mergers, strategic partnerships and convenient care clinics in New Jersey. I have prepared market analyses and expert testimony for clients of the Dorsey & Whitney and Halleland Lewis law firms and the Martin Williams and Periscope advertising agencies.
Blue Cross of Washington and Alaska (BCWA). Working with the actuarial consulting firm of Reden & Anders, helped BCWA to analyze its challenges and opportunities under the health reforms in Washington state and Oregon and to devise business and policy strategies.
Oakwood Healthcare System/Michigan Affiliated Providers. Assessment of purchaser perspectives on health benefits, providers and health plans in southeast Michigan for physician-hospital joint venture organizations.
Illinois Healthcare. Analysis of marketplace issues affecting future business prospects of a possible health plan acquisition. Conducted interviews with key purchasers and tied to information about competitors and local trends.
Neighborhood Health Care Network (NHCN). Market analysis for 16 community health centers forming NHCN as a vehicle for contracting with HMOs and providing centralized administrative services; currently serving on board of management services organization.
NWNL Health Management Corporation (NHMC). Research on emerging provider networks and new HMOs in developing managed care markets and their potential interest in–and need for–purchasing health plan management services from NHMC. I made the first contact with networks that later became clients of NHMC.
Nonprofit Clinic Consortium. Assessment of market challenges and opportunities for Washington, DC, nonprofit clinics seeking to collaborate and configure themselves to deal with changes in Medicaid and publicly supported primary care for underserved populations. The research was supported by the Annie E. Casey Foundation.
GlaxoSmithKline, Integrated Healthcare Division. Assessment of trends and issues in two Midwestern states, looking at HMO and hospital market competition, financial performance and developments in provider integration and purchaser initiatives.
United States District Court, Northern District of Oklahoma, and Oklahoma Department of Human Services. Evaluation of state management of community services for persons with developmental disabilities and assessment of the likely impact of moving disabled Medicaid recipients into managed care.