Description

After pausing while the US healthcare industry struggled to contain COVID-19, the stringent audit process for value-based care (VBC) is back in full swing for 90% of Medicare reimbursement that is currently attributed to some form of quality or risk-based payment plan. Additionally, CMS has launched new guidance for value-based reimbursement among the Medicaid population, in which 67% of reimbursement remains fee-for-service (FFS).

The expanded scope of VBC will compel health systems to invest in a range of public health management (PHM) capabilities that cover all types of government-sponsored health insurance and demonstrate proven ability to meet quality performance criteria for specific insured populations (e.g., Medicare Advantage, Medicaid Advantage, and Long-Term Services and Supports).

Accountable care organizations (ACOs) are increasing their enrollment into risk-based payment plans (from 9% of all ACOs in 2017 to 74% in 2020) and driving adoption of PHM solutions that aid cross-continuum data interoperability and integrated care management.

However, next-generation ACOs (NGACOs) that pioneered adoption of VBC payment plans are failing to report the desired business outcomes. In fact, 50 such NGACOs reported additional spending of $93 million in the first 2 years of their program against savings of $86 million, which they reported in the first year of the same program. Consequently, they are devising PHM strategies that guarantee improved financial outcomes while being clinically result-oriented and operationally streamlined.

In a field of more than 50 industry participants, Frost & Sullivan independently plotted the top 11 companies in this Frost Radar™ analysis. The Radar™ reveals the market positioning of each company using its Growth and Innovation scores as highlighted in the Frost Radar™ methodology. The document presents competitive profiles on each company based on its strengths, opportunities, and market positioning. We discuss strategic market imperatives and the competitive environment that vendors operate in as well as make recommendations for each provider to spur growth.

Author: Koustav Chatterjee