Commentary
MEET THE PAYMENT REGION – COST CONTROL DOMINATES THE FIELD
The Payment region includes several veteran teams, including two All-Stars, Direct Contracting with Employers and Price Transparency, which have made it into the tournament all five years. Many prognosticators agree that Medicare Advantage Doubles Down will be a hard one to see past. While not technically an All-Star, as it was a first-timer in 2022, Medicare Advantage (MA) has more than proven that it’s a force to be reckoned with, having entered the tournament four times as the number one seed in its region and making it to the championship round twice in those four years. However, it has yet to take the crown, proving that even giants have their weak spots.
This corner of the bracket has been called “contentious,” “compelling,” and “competitive,” and it’s clear that cost control is the undercurrent here, with stakeholders becoming laser-focused on the issue of cost. Expect some exciting game play from the Payment region!
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THE EIGHT TRENDS AND THE FIRST FOUR MATCHUPS
This region’s contests begin with a showdown between the gargantuan MA Doubles Down (1) and newcomer A New Era of Benefits Administration (8), a game that might be more fun to watch than you would expect. While any topic involving MA has an edge from a legacy team that represents 33 million people with above-average healthcare utilization, A New Era of Benefits Administration is coming out swinging. Employers are anticipating a nearly 8% increase in healthcare costs for 2025, the highest single-year increase in 15 years, and they are desperate for new plans and management strategies to help control costs.
Next up, Disease- and Condition-Specific Payments (2) accepts the challenge from Fall of PSHPs (7), a battle of tournament rookies. Can the Center for Medicare and Medicaid Innovation’s increased focus on disease-specific models to improve care and reimbursement efficiency make a dent in healthcare? More importantly for this tournament, can this trend hold its own against the fall of an entire business model, as more health systems announce plans to sell their provider-sponsored health plans?
Prepare for fireworks as Control of High Prescription Drug Costs (3) returns to a third tournament and takes on All-Star Price Transparency (6). This clash pits two feisty teams that always land in the middle of the field with the promise of great and noble deeds. Pharmacy-related costs now account for more than 25% of employers’ healthcare budgets, and employers are eager to uncover and leverage solutions. On the other side of the hardwood, price transparency has done the impressive job of receiving support in both former and current federal administrations.
Completing Round 1 for this region is a bout between newcomer Acceleration of Commercial Risk (4) and tournament All-Star Direct Contracting with Employers (5). Pundits are not holding out much hope for excitement at this game. Some are surprised that Acceleration of Commercial Risk even made it into the tournament, and others are lambasting Direct Contracting for having only spotty, regional influence, despite the fact that this trend continues making it into the March Healthcare Classic year after year.
Read about the trends in the other three regions: Healthcare Landscape, Care Delivery and Technology.
What trends do you think are the biggest healthcare change-makers?
Join the conversation on LinkedIn and make your predictions by March 14.