A new Guidehouse analysis outlines several markets the consulting firm says should be prime targets for "payviders," or risk-based payer-provider collaborations.
The Detroit, Miami, Phoenix and Tampa, Florida, regions are among those most ripe for these collaborations, according to the report, as they represent significant growth potential based on local competition and demographics.
Payers and providers operating in these markets have opportunity to "differentiate" their value-based care work through models such as provider-backed health plans or payers directly employing docs, according to the report.
Guidehouse studied 100 markets with at least 500,000 people across the U.S. for its index. The report identified Portland, San Francisco and Minneapolis as markets where payviders are currently thriving the most.
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Competitors in these markets should instead focus on refining their value-based programs to take advantage of the potential for significant membership growth, according to the report.
“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," said Aimee Sziklai, Guidehouse partner and Commercial Payer leader, in a statement. "When done right, payvider models can turn organizations into growth engines that support sustainable margins and better health for all."
Payers and providers should be investing in these relationships now for a number of reasons, according to the report. For one, Medicaid managed care continues to grow and is now deployed in 40 states.
In addition, Medicare Advantage is the fastest-growing segment of health insurance. Both types of coverage center on risk-based arrangements that offer opportunity for "payviders" to get aggressive about value-based care, according to the report.
In order to form a successful "payvider" dynamic, payers and providers need to set aside the traditionally contentious way they negotiate contracts. Collaborators who find success incorporate the triple aim goals of lower cost, higher quality and better service as key focuses, Guidehouse said.
"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, M.D., director at Guidehouse, in a statement.