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Research & Reports

Searching in Market Access (2019)

Philadelphia | Pennsylvania | 2017 | Market Overview (Event Driven)

Jefferson Health and University of Pennsylvania Medicine are establishing themselves as the major healthcare delivery brands in Philadelphia, with each acquiring hospitals in the Philadelphia suburbs and in New Jersey. The dominant insurer continues to be local favorite Independence Blue Cross, which outlasted national rivals Aetna and UnitedHealth in the state's individual health insurance exchange and has an edge on the region's Medicaid population. As Jeff and Penn have bought up viable hospitals to fill holes in their respective service areas, both may be shifting focus to establishing more-convenient points of access, such as outpatient centers and post-acute care. IBC is also looking to engage more directly with patients and physicians through organizations like Tandigm Health. While Penn and Jeff may each add another local health system in the coming year, expect both to focus on adding population health management capabilities.

Questions Answered in This Report:

  • The acute-care expansion strategies of Jefferson Health and Penn Medicine do not quite overlap, showing a predilection for the former to head north and the latter west. Instead of having suburban hospitals directly compete, the two powers may fill their service area gaps with outpatient centers. Which health systems have Jeff and Penn acquired, and which are possible targets? Which national for-profit systems are buying Philadelphia hospitals, and which may pull back their local presences? How have local systems adapted to the clinical integration model?

  • Philadelphia health systems and insurers are developing population health capabilities, making physician engagement critical. Which health systems are using the accountable care organization model to align with their physicians? Which health system-backed ACOs have failed or reconfigured in the past year? How are independent-minded physicians reacting to pressure to integrate with health systems?

  • With Aetna and UnitedHealth exiting the 2017 exchange and losing out on Medicaid bids from the state, Independence Blue Cross continues to assets itself as the dominant payer in the Philadelphia market. How have insurers attempted to introduce narrow- and modified- provider networks into the region? Why has the state's Medicaid contracting process been so contentious? Which health systems are working with insurers on value-based reimbursement?

Scope:

Market Includes: Philadelphia, which includes the counties of Bucks, Chester, Delaware, Montgomery, and Philadelphia

Primary Research: Analysis of Decision Resources Group data, local and state news and industry reports and interviews with local healthcare executives.