Vertically integrated provider systems have rationalized services and invested in infrastructure to manage risk on a global basis. Consolidation of HMOs. Consolidation of physician organizations, hospital systems and integrated systems. Competitive Strategies Payers compete on price, benefits. Payers compete on price.
Payers compete on price, outcomes, consumer satisfaction.
Provider Panel Undifferentiated provider panel among payers. Reduction of provider panels to eliminate higher cost, lower quality providers. Strategic alliances with organized providers. Provider Payment Providers paid on discounted fee for service and per diem basis. Physician organizations and hospitals capitated with joint risk-sharing arrangements.