BURLINGTON, Mass., Dec. 4, 2018 /PRNewswire/ -- Decision Resources Group (DRG) a premier provider of high-value healthcare data, analytics and insights products and services, announces new findings from the DRG National Managed Care Organization Commercial Analyzer. As the managed care market pursues vertical integration and diversification, DRG sees disruptive change ahead for the U.S. healthcare system.
DRG's latest MCO Analyzer Commercial Landscape report finds that a key aspect of the current healthcare evolution is the development of regional integrated delivery networks, where co-owned and partnered hospitals are banding together as a regional system near urban centers. Such structures can frustrate carriers' attempts to gain competitive hospital contracts but have the advantage of providing greater support for IDN-affiliated hospitals in exurbs and small towns.
Even the largest hospital chains are organizing their holdings into regional networks to consolidate their oversight and maximize the potential for collaboration. The systems can include affiliated home health, hospice, rehabilitation and nursing facilities. As more insurers seek value-based contracts with high-performing hospitals, these regional systems will be able to support shared electronic health records and technology assets to make these arrangements work well.
Additional key commercial market developments in 2018 according to the DRG National Managed Care Organization Commercial Analyzer include:
- Employer frustration over drug prices: Employers are reaching for some new tools in their efforts to contain medical costs, including drug benefit changes, direct contracts with providers, greater use of employer-based clinics, hired health coordinators and coaches, and more.
- Carriers push providers toward downside risk: Carriers are taking different approaches to getting value-based providers to assume downside risk.
- Insurer-PBM mergers: Mergers won't resolve the push for transparent pricing but may better position health plans to deliver better clinical support to physicians and prescribers.
- Largest employers explore new healthcare options: From Amazon to Walmart, more top employers are trying out new ways to deliver lower-cost healthcare to their employees.
Comments from DRG Principal Analyst Paula Wade: "Every segment of the healthcare system â from physician practices to the largest insurers â are merging, diversifying or aligning themselves with larger players to prepare for whatever policy changes or competitive game-changers are ahead â whether it's the end of the ACA, a move toward Medicare-for-all, or a transformative development from Google."
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About Decision Resources Group
DRG, a subsidiary of Piramal Enterprises Ltd., is the premier source for global healthcare data and market intelligence. A trusted partner for over 20 years, DRG helps companies competing in the global healthcare industry make informed business decisions. Organizations committed to the developing and delivering life-changing therapies to patients rely on DRG's in-house team of expert healthcare analysts, data scientists, and consultants for critical guidance. DRG products and services, built on extensive data assets and delivered by experts, empower organizations to succeed in complex healthcare markets.
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