Meet the Clinical & Business Model Region: The Providers Defend Their Turf
Let’s take a look at the Clinical & Business Model region in the 2023 March Healthcare Classic.
In the Clinical & Business Model region, matchups show what’s happening in the provider ecosystem to influence change in healthcare. Clinicians drive transformation primarily based on their personal interactions with patients in tandem with their business model, and if they don’t see value in quality and safety for their patients or increased revenue, they aren’t going to get behind whatever initiative is in front of them. Many of these trends seem to be bubbling up at once, so an important part of the conversation is not just which trends are most important, but in what order and/or combination should they be adopted?
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The Eight Trends and the First Four Matchups
Leading the pack in this region is Medicare Advantage. A number one seed last year, this trend made it all the way to the championship game, losing in a huge upset to 2022 bracket-buster Workforce Challenges. It’s back for revenge this year, and has a good shot due to continued and sustained growth, despite recent scrutiny for questionable practices. It takes on another return player, Omnichannel Healthcare, which includes all the alternatives to inpatient care that can drive down healthcare costs. Vendors that offer omnichannel capabilities may have a competitive edge over those that don’t.
Vertical Integration was a seven seed last year and has moved up the ladder to the number two spot in this region. This trend is strong and will continue, as more organizations become payviders, acquire PBMs and retail, or otherwise blur the lines between payers and providers. Vertical Integration is seen by many as one of the only realistic ways to control costs and will meet Retail Healthcare in Round 1. This seventh-seed trend is defined by healthcare conducted at retail outlets such as Walmart, Amazon, Walgreens and CVS. Offering services in familiar retail settings may make healthcare more accessible and convenient, and the larger players have the ability to scale up quickly.
At a number three seed is Total Cost of Care. 2023 is predicted to be the year that providers get more aggressive in accepting risk for populations to address affordability and health equity. It takes on Membership Models, which like concierge medicine, represent a fringe area of healthcare that is highly appealing but inaccessible by most. This trend is somewhat of a wild card player this year – and at number six in this region, it will be interesting to see how far it goes.
Primary Care Transformation is largely seen as the most important area of reform in healthcare, but opinions vary about how this should happen. New government spending on chronic disease prevention and health promotion, coupled with consensus around value-based care, stand to catalyze lasting change in Primary Care Transformation. This fourth seed will meet number five seed Specialty Care Transformation, which may not touch as many lives as Primary Care Transformation but could be more open to change.
Read about the trends in the other three divisions: Healthcare Economy, Purchasers, Digital Tools & Technology.
What trends do you think are leading the pack?
Join the conversation on LinkedIn and make your predictions by March 8.