Commentary
MEET THE PAYMENT REGION: HELLO, STRESS FRACTURES
Focused on cost, economics, and financial risk, this region sees the return of several power players, most remarkably, the Evolution of Medicare Advantage, which enters the tournament for the third year running as a number-one seed. This blue-blood team, having lost in the final championship game in 2022 and knocked out in the Round of 16 last year, is hungry for a big win and brings to the court an impressive, champion-level bench of factors. This field also includes two teams that have appeared in every single tournament to date – two of only four in this tournament with such a credential. As prolonged economic pressures in this territory are finally causing cracks and warps, the Payment Region in 2024 does not disappoint.
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THE EIGHT TRENDS AND THE FIRST FOUR MATCHUPS
In the first matchup, newcomer Pursuit of Pre-Payment (8) boldly takes on the powerhouse Evolution of Medicare Advantage (1), a bout that is not likely to last long. We’ve got to give an A for effort to providers using pre-payment as a way to fund care model transformation and eliminate administrative burdens caused by fee-for-service models.However, in the face of sweeping regulatory changes and health systems going out-of-network with some Medicare Advantage plans, the number-one seed has the distinct “advantage” in this battle.
The next contest puts in first-timer Acceleration of Risk-Bearing Specialties (2), in which specialists are aligned and incentivized on risk-based metrics, requiring more collaboration between primary care providers and specialists. This trend goes up against staunch veteran Economic Impact of SDoH and Health Equity (7), an all-star trend that has appeared in one form or another in every tournament to date. In 2024, this trend focuses on providers having to shift from measuring to managing social determinants of health factors and health equity driven by value-based payment models.
Third seed, Growing Primary Care Memberships, made its debut last year but in a different region. As a player in the Payment Region, this trend suggests that 2024 may see the highest rates of individual consumers directly purchasing healthcare from Amazon, CVS Health, Walgreens, Walmart and other major retailers offering primary care membership models. It takes on six-seed Demise of the RVU, a continued transition away from fee-for-service as the predominant payment model in which more physicians are paid for quality, outcomes, and patient experience.
The mid-field matchup for this region is between championship mainstay Increase in Direct Contracting (4) and Mark Cuban Effect on PBMs (5). As employers of all sizes continue to grow frustrated with the rising costs in the current system, 2024 will see an uptick in direct contracts between employers and providers. How will this movement stack up against the momentum to drive down the high cost of drugs, as employers seek alternative pharmacy benefit managers that do not receive payments from drug manufacturers, as exemplified by the Mark Cuban Cost Plus model?
Read about the trends in the other three regions: Healthcare Landscape, Delivery, and Technology.
What trends do you think are leading the pack?
Join the conversation on LinkedIn and make your predictions by March 13.