Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries
Exploring Critical Business and Legal Issues across the Healthcare and Life Sciences Industries

Top Takeaways | Employer Market Perspective

By on October 10, 2023
Posted In Uncategorized

In this session, McDermott Will & Emery Partner Patrick Healy moderated a panel that examined the expansion of value-based care in the employer market. We summarize the panel’s insights on how stakeholders can successfully implement value-based models in the employer market.

Session panelists included:

  • Mark Miller, Chief Commercial Officer, Wildflower Health
  • Simeon Niles, Vice President of Health Care Innovation, Morgan Health
  • Carl Landry III, Director, Healthcare Strategy, Guidehouse

Top takeaways included:

  1. Motivated by the unsustainable increase in healthcare spending and new consolidation and joint ventures among providers and health insurers, there is an accelerated need for solutions in the employer market. If the employer market does not self-regulate, the market fears that regulators will step in.
  2. Regarding the relationship between employers with self-funded plans and third-party administrators (especially those owned by health insurers), there is confidence that third-party administrators’ historical relationships with employers will generate more turnkey programs producing easier-to-integrate value-based care models.
  3. There is a particular emphasis on how smaller employers will utilize employee data and implement value-based care models in comparison to jumbo employers.
  4. Significant interest in the jumbo-employer market is met with limited adoption and penetration of value-based care models when compared to the Medicare/Medicaid space. It is unclear whether these challenges are due to structural issues in the employer market limiting the pace of adoption. Such structural issues include employers as individual purchasers of coverage (as opposed to aggregate bulk purchasers); associated pools of covered lives too small for providers to take risk; lower per-enrollee healthcare spend; and lack of clarity on the optimal, most-scalable value-based model (e.g., total cost of care, quality bonuses, upside only, episode payments).




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