Washington, D.C., is a challenging market for payers and providers. The Maryland portion of the market has embraced payment reform with an all-payer model that puts hospitals at risk and sets standard reimbursement rates. Maryland’s model constraints cost increases and encourages innovative programs. Meanwhile, in northern Virginia, there are strong clinically integrated networks that use provider incentives to improve quality, but physicians are resistant to full-risk reimbursement models. The district, meanwhile, has struggling safety-net facilities that need expensive modernization and a higher Medicaid population than the surrounding states. Payers maintain influence across the market, and integrated delivery networks also exert control. Look for payers and providers to stick with proven generics to manage costs but also consider new, branded drugs that offer proven outcomes.

Related Reports

Las Vegas | Nevada | 2020 | Market Overview

While Las Vegas hospitals grow incrementally, the impact of the COVID-19 pandemic threatens to hurl the market back into a recession, and the last recession took longer to end in the Las Vegas mark...

View Details

Nashville | Tennessee | 2020 | Market Overview

Nashville’s IDNs are expanding outside the immediate metro area in response to rapid population growth and evolving their care continuums, provider alignment, clinical integration and reimbur...

View Details

Colorado Springs | Colorado | 2020 | Market Overview

Colorado Springs health systems show no sign of slowing down, even as the COVID-19 virus impacts hospital finances. Several midsize medical groups are poised to make moves as a growing market provi...

View Details

Riverside | California | 2020 | Market Overview

Riverside is different from other innovative markets in that population health is not easy to manage. People in the Inland Empire tend to have more chronic health issues compared to other parts of...

View Details