DRG’s Josh Kelley, Senior Director, US Regional & Customer Segment Insights, will be presenting at this year's Partnering with IDNs Bio Pharma Strategy Summit.
Mega-IDNs Rattle Payer Landscape
IDNs are increasingly taking on the role of payer through direct employer contracting, health plan ownership, and risk-based contracting with insurers. Understanding how these factors impact IDNs’ behavior and strategy is critical to developing an effective engagement strategy with these dominant provider organizations. There has been a marked uptick in the trend of employers bypassing traditional insurers to contract directly with IDNs. In response to IDNs’ growing power, traditional MCOs are fighting back to regain control and combat the influence of IDNs on the delivery of healthcare.
- The growing control of IDNS over benefit design, formulary, cost controls, and disease management as they engage in varying levels of direct contracting with employers.
- Variability of risk-based contracting among the largest, most influential IDNs
- How IDNs’ approach to reimbursement relates to clinical integration and provider alignment
- Efforts by employers to explore bypassing PBMs to directly contract with drug manufacturers in an effort to better control Rx spending/supply chain.
- Enrollment trends for IDN-owned health plans amid the volatility of health insurance exchanges and Medicaid expansion.
- How MCOs are fighting back and putting increased premium/cost transparency pressures on IDNs.
If you would like to arrange a meeting with one of our experts, please contact us.