The battle for control of the healthcare dollar is heating up across the landscape of medical-care delivery. And unlike last year's wildly unrealistic, centralized command-and-control scenario, this market-driven effort is quickly picking up steam.
A not-for-profit Colorado cooperative called JustCare is being created to bring together employers and providers in statewide networks linked by a national electronic claims processing and payment system.
This week's cover story (p. 28) highlights efforts by a 24-member business coalition in Minneapolis, the Business Health Care Action Group, to launch one of the most ambitious direct contracting programs in the nation, bypassing the mega-managed-care firms and dealing directly with providers.
Another group in formation is the National HMO Purchasing Coalition, which will represent eight large employers, including American Express and Marriott International, and a buying pool of 600,000 people. It's just a matter of time until national coalitions have the bargaining clout to broker big deals involving providers seeking big market share gains by offering volume deals to employers.
To be positioned for the coming battle, healthcare executives must keep their weapons at the ready. That means being prepared to contract directly or to participate in networks that offer value to purchasers seeking high-quality managed care.
To achieve that end, executives must focus on analyzing the community's health needs, flattening excessive management layers, clinically re-engineering to better utilize physicians and nurses, and increasing integration with payers to reduce overall administrative costs.