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Knowing Your Market and Your Competition: Steps for Success
Kenneth T. Hertz, FACMPEIndependent Consultant
MGMA Health Care Consulting GroupMGMA-ACMPE Annual Conference
October 6, 2013
All Markets are local
How is The Choice made?
Word of Mouth
Family Support
Transportation
Follow up care
Ancillary Services
Consumer reviews
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Payer market concept for providers
Product for saleNo providers. No product
Network for membersBuy servicesBuy time
Quality and cost efficiency for buyersEmployers = Ultimate consumer
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Strategic Plan for your local market
Local costs
Local politics
Local plan purchasers
Local resources
National plan purchasersInternational plan purchasers
© 2013 MGMA Health Care Consulting Group. All rights reserved.
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?
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Who do the payers serve?
Member/Employees demographics
ScreeningTreatment
Health
© 2013 MGMA Health Care Consulting Group. All rights reserved.
How do you fit in their strategic plan?
Cost
Access
Quality
Efficiency
Reporting
© 2013 MGMA Health Care Consulting Group. All rights reserved.
What do they want from you?
.
Individual Patients
Patient Population
Episode Management
Administration
© 2013 MGMA Health Care Consulting Group. All rights reserved.
How do you distinguish yourself?
Payer Recognition Program
Range of Services
EfficiencyTo treatment resultsCost
Relationship with Provider Representative
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Do you know the characteristics of your competition?
From the Payer Network Panel
Primary Care
Outpatient
Hospitalists
Clinical diagnosis
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Who is like you on the payer panel?
Other Gastroenterologists
Check healthgrades scores www.healthgrades.com
Areas of vulnerabilityAccessBedside mannerPractice operations
© 2013 MGMA Health Care Consulting Group. All rights reserved.
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?
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Who needs to know how/what you do?
The payer-directory listing
Primary Care panelCardiology panelGynecology panelPulmonary panel
Physicians new to the area/panel
© 2013 MGMA Health Care Consulting Group. All rights reserved.
What are the characteristics of competition?
Volume fluctuation
Change in:scheduling patterns demographicsreferral patternspayer mixcash flow
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Local characteristics of competition
Word of mouthDoctor’s loungeLocal employers Employer associationsInsurance brokersLocal plansPayer hospital associationsHealth fairsCharity events
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Using payer resources to assess competition
Payer panel listingSteerageUtilization Review CommitteeQuality Reports Episode of care feedbackCost unfiltered clinical guidelines
Evidence-based medicine
Data…data…data
© 2013 MGMA Health Care Consulting Group. All rights reserved.
How do you add value?
Quality + Cost = Value
AccessibleAffableAffordable
Population HealthThink from who pays the premiums
© 2013 MGMA Health Care Consulting Group. All rights reserved.
You serve who the payer serves…
Members = patients
Employers = consumers
Payers = project manager
Provider Panel = Team
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Payer creates competition within the team
To provide efficient costs to consumer
Disadvantage competition costs not knownpayer knows local market costspossible steerage
© 2013 MGMA Health Care Consulting Group. All rights reserved.
Payer created competition….if you are good
AdvantageMethod to distinguish yourself in recognition programsSteerageFee differentialLocal relationships and referral patternsSponsored screening events
© 2013 MGMA Health Care Consulting Group. All rights reserved.
How do you add value to compete?
Quality + Cost = ValueAccessibleAffableAffordable
Population HealthThink from who pays the premiums
Clinical QualityQuality of the Patient ExperienceQuality of Outcomes
© 2013 MGMA Health Care Consulting Group. All rights reserved.