Assessing Your Situation – Market Assessment

The next step is to take a close look at the market or markets in which your organization operates. What communities and populations does it serve? How much competition is there among provider organizations? Who are the major payers in your market?

Market Area

• What is the demographic makeup of your patient population? How is this likely to change in the future, and what are the implications for your organization?
• How well does your organization understand community needs at a sub-population level? What are the sub-populations, and what challenges and opportunities do they present for your organizations?
• How do you predict that the needs of the populations you serve will change in the future? How well do you think your organization can adapt to meet these needs?

Provider Market

• What is the competitive landscape in your market area? How is it changing, and what are the drivers of these changes? What are the potential implications of changes among/by competitors for your organization?
• Which organizations among your competitors are real threats? Why?
• Which organizations among your competitors represent potential partners? Why?

Payer and Purchaser Market

• Does a single payer dominate your market or is there competition among payers?
• How aggressively are payers moving toward value-based reimbursement?
• How are payers determining with which providers to partner on new payment methods, population health infrastructure, limited networks, etc.? Is your organization a potential partner, or is it excluded from these discussions? What would make it a more attractive partner?
• How prevalent are provider-owned plans in your market? What is the potential for new provider-owned plans to develop?
• How influential is the employer purchasing community in your market? What demands and expectations do they have of providers, and how are these changing?
• What impact, if any, have insurance exchanges and limited network plans had? What is the potential, and what are the possible implications for your organization?

Reflecting on your answers

After reviewing the answers to your organizational and market assessment, how would you answer the following questions?

• How will your organization fare in an environment of both fee-for-service and value-based payment in its current state? Would it fare better if it pursued some form of acquisition or affiliation?
• How much effort and investment lies ahead to prepare for population health management, which is required under most value-based payment mechanisms? Is your organization equipped to dedicate the needed effort and capital, or will it need additional resources?
• Is your organization’s strongest position for negotiating participation in an acquisition or affiliation model now or later?