Guidehouse Designates US Markets Ripe for “Payvider” Adoption and Growth

WASHINGTON, June 3, 2021, Guidehouse, a leading global provider of consulting services to the public and commercial markets, has released its inaugural Center for Health Insights Index in a new report that identifies markets ripe for payviders: risk-based collaborations between payers and providers.

The Greater Detroit, Miami, Phoenix, and Tampa areas were among the markets with the greatest opportunities for payvider adoption and growth, according to the Guidehouse Center for Health Insights Payvider Market Index. These markets represent high value-based growth potential given competitive dynamics and demographic/payer changes, with an opportunity to differentiate value-based payment and delivery operations.

"The rules of the game for delivering high-quality, cost-effective, consumer-centric care are changing, and healthcare organizations are at an inflection point,” said Michael Nugent, partner at Guidehouse. “Margin is moving to the beat of the market, risk-based payment, and consumerism. Where an organization is positioned in their market greatly influences their business model. This has created a demand and urgency for payviders, where payers and providers must work in harmonious accountability to succeed."

To help payers and providers broadly understand where they can most effectively uncover opportunities for payvider models, Guidehouse evaluated more than 100 US markets with a population of 500,000 or more based on market size and future growth, as well as current-state value-based payment performance. The Payvider Market Index identified markets that are ripe for payviders, those with potential for greater scale, and those that need the capabilities to better manage risk.

According to the Index, the Greater Minneapolis/St. Paul, Portland/Vancouver, and San Francisco areas were among the markets with the highest performing payviders. These areas can expect further membership growth potential given strong performance and demographic/payer changes, with an opportunity to refine existing value-based payment and delivery operations to retain new members.

"The Centers for Medicare & Medicaid Services is aggressively shifting to managed care as its preferred model and private-equity-backed, tech-enabled disruptors are steering business away from poor performers,” said Aimee Sziklai, Guidehouse partner and Commercial Payer leader. “Providers and payers must be prepared to both share risk and understand where market opportunities for risk-sharing exist so that they can compete for members. When done right, payvider models can turn organizations into growth engines that support sustainable margins and better health for all."

The report discusses why now is the time for payers and providers to form aggressive shared-risk arrangements that take advantage of opportunities in their market. For example, 40 states are leveraging managed care models to deliver Medicaid services. Additionally, Medicare Advantage has become the fastest-growing health insurance market segment.

"As we’ve seen with Medicare Advantage and managed care organizations, key to success is a competitive market with payer and provider arrangements that share the financial benefits of quality and efficiency improvements, support innovations in care, and enhance the member experience,” said Nicole Fetter, MD, director at Guidehouse. “We’re actively working with payers and providers across the public and private sectors to help them understand their market position and capitalize on opportunities that will set them up to best care for their communities.”

The full report lays out strategies for building successful payvider business models focused on the Triple Aim, including how to strategically, financially, and operationally align scorecards to put members first, as well as the capabilities needed to initiate successful negotiations, member enrollment, and point of care transitions, payment, and coordination. Guidehouse works with payers and providers to identify market opportunities in detail to design and implement innovative risk-based payment and care delivery strategies, partnerships, and models.

Learn more and download the full report here: http://bit.ly/payvidermarketindex.

Guidehouse Center for Health Insights Index reports provide data-driven, strategic, and pragmatic solutions for healthcare organizations to succeed in today’s disruptive environment. Guided by Guidehouse Health experts, the Center has a complete view of healthcare payment, operational, and consumer disruption insights and solutions.

The Guidehouse Health segment includes Public Health, Provider, Commercial Payer, State Health, and Life Sciences practices. Collectively, the team is composed of former provider and public health administrators, clinicians, scientists, pharmaceutical executives, and other experts with decades of strategy, policy, revenue cycle, digital, retail health, managed care, and managed services experience. With 11 KLAS #1 rankings, the Guidehouse Health team helps hospitals and health systems, government agencies, life sciences companies, employers, and payers strategically redesign, revitalize, and transform care delivery and operations.

About Guidehouse
Guidehouse is a leading global provider of consulting services to the public and commercial markets, with broad capabilities in management, technology, and risk consulting. We help clients address their toughest challenges and navigate significant regulatory pressures by focusing on transformational change, business resiliency, and technology-driven innovation. Across a range of advisory, consulting, outsourcing, and digital services, we create scalable, innovative solutions that prepare our clients for future growth and success. The company has more than 10,000 professionals in over 50 locations globally. Guidehouse is a Veritas Capital portfolio company led by seasoned professionals with proven and diverse expertise in traditional and emerging technologies, markets, and agenda-setting issues driving national and global economies. For more information, please visit www.guidehouse.com.