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Research & Reports

Searching in Market Access (2102)

Raleigh | North Carolina | 2017 | Market Overview (Event Driven)

The highly consolidated Raleigh market’s movement toward value-based care has led to greater collaboration among health systems and hospitals, physicians, and payers, and has given rise to clinically integrated networks. The market’s three largest health systems are utilizing these networks to contract with payers under alternative payment models, including accountable care contracts. Health systems and hospitals are also collaborating to expand access to services in response to rapid population growth, including lucrative specialty services such as cardiology and oncology. Insurers' collaborations with providers continue to produce narrow-network plans that promise cost-savings and are gaining popularity with employers and individuals. As the Raleigh market’s population swells and providers expand facilities and services to keep pace, look for increased opportunities for medical and drug utilization.

Questions Answered in This Report:

  • Health systems in the Raleigh market are expanding access to specialty services through partnerships and the construction of new facilities. Which health system opened a new heart and vascular hospital, and what effect will this have on the market? Which health systems are aggregating resources to strengthen their specialty services programs? How are health systems collaborating around alternative payment models?

  • Physicians in the Raleigh market are largely consolidated. What are the most popular alternative payment arrangements locally? Which physician groups are participating in the CMS Bundled Payments for Care Improvement initiative? Are physician groups taking on risk through performance-based contracts?

  • Insurers in the Raleigh market are collaborating with health systems to offer narrow-network and tiered-network plans. Which carriers have eliminated broad-network plans from the state's health insurance exchange? Which carriers operate accountable care organizations in the market? How might carriers benefit from the state's plan to transition the fee-for-service Medicaid program to a managed Medicaid model?

Scope:

Market Includes: Raleigh, which includes the counties of Chatham, Durham, Franklin, Johnston, Orange, Person, and Wake

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