Knowing Your Market and Your Competition: Steps for Success Kenneth T. Hertz, FACMPE Independent Consultant MGMA Health Care Consulting Group MGMA-ACMPE Annual Conference October 6, 2013
All Markets are local How is The Choice made?
Payer market concept for providers Product for sale No providers. No product Network for members Buy services Buy time Quality and cost efficiency for buyers Employers = Ultimate consumer
Strategic Plan for your local market Local costs Local politics Local plan purchasers Local resources National plan purchasers International 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? Health Treatment Screening Member/Employees demographics
How do you distinguish yourself? Payer Recognition Program Range of Services Efficiency To treatment results Cost 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 vulnerability Access Bedside manner Practice operations
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 panel Cardiology panel Gynecology panel Pulmonary panel Physicians new to the area/panel
What are the characteristics of competition? Volume fluctuation Change in: scheduling patterns demographics referral patterns payer mix cash flow
Local characteristics of competition Word of mouth Doctor’s lounge Local employers Employer associations Insurance brokers Local plans Payer hospital associations Health fairs Charity events
Using payer resources to assess competition Payer panel listing Steerage Utilization Review Committee Quality Reports Episode of care feedback Cost unfiltered clinical guidelines Evidence-based medicine Data…data…data
How do you add value? Quality + Cost = Value Accessible Affable Affordable Population Health Think 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 known payer knows local market costs possible steerage
Payer created competition….if you are good Advantage Method to distinguish yourself in recognition programs Steerage Fee differential Local relationships and referral patterns Sponsored screening events
How do you add value to compete? Quality + Cost = Value Accessible Affable Affordable Population Health Think from who pays the premiums • Clinical Quality • Quality of the Patient Experience • Quality of Outcomes