How well does your health system cover its region? Does your clinically integrated network influence a wide swath of physicians and align them through value-based contracts?
This article appears in the July/August 2018 edition of HealthLeaders magazine. It is a sidebar to the article "Market Share Still Matters: 3 Ways to Win."
Mark Cherry, principal analyst at Market Access Insights for Decision Resources Group, says his team wrestles with questions of how to best evaluate the strength of health systems over the long term.
"Even still, we measure market share by inpatient volume," says Cherry.
"Everyone's focusing more on outpatient care, but how do you put that in a number that's easy to compare?" he asks. "In addition to market share, how complete is it as an ecosystem? Can you stay within that integrated delivery network for all your needs? How well do they capture the patient experience so [patients] never leave?"
"10 years ago, health systems were still thinking larger equals leverage and not necessarily about efficiencies."
—Mark Cherry
While it's difficult to consolidate these new metrics into an all-encompassing number, Cherry and others are attempting to make such judgments more quantitative. Cherry's team uses five pillars to measure the strength of a healthcare system:
- Regional presence
- Provider alignment
- Continuum of care
- Advanced reimbursement
- Clinical integration
Each health system is scored on those pillars—ranked at an early, middle, or advanced stage.
But beyond those more objective evaluation tools, Cherry says determining the long-term trajectory of health systems' overall business requires a nuanced approach.
Related: Market Share Still Matters: 3 Ways to Win
For instance, how well does your health system cover its region? Is every potential commercial insurance customer within five to 10 miles of a retail clinic or micro-hospital? Does your clinically integrated network influence a wide swath of physicians and align them through value-based contracts of some sort? If so, maybe your narrow network is essential to commercial health plans, which is critical.
"Maybe your narrow network doesn't seem so restrictive for patients," says Cherry, who adds that patients are getting more involved in healthcare decision-making every day. "Maybe your narrow network seems almost like a club."
"10 years ago, health systems were still thinking larger equals leverage and not necessarily about efficiencies," he says. "But lately, it's been more work with insurers to lower premiums, which is the whole point of narrow networks."
Philip Betbeze is the senior leadership editor at HealthLeaders.