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Healthcare Localization: The Importance of State and Regional Insights

As the US healthcare system continues to evolve, one of the key trends is how healthcare is coordinated and administered. More and more, healthcare is being delivered at a hyper local level. The drive by payers and providers toward higher quality, lower cost care has triggered the consolidation and coordination of local health systems to achieve this goal. This has triggered a lot of activity in terms of partnerships, mergers and acquisitions and how regional healthcare providers are affiliated.

 

 It's important to keep track of these mergers because it could influence what doctors you see or where you get your care delivered from so it really impacts every aspect of the healthcare ecosystem

Sarah Wilson, Principle Analyst Market Access Insights, Decision Resources Group

 

Integrated Delivery Networks and their growing prevalence is one of the key shifts in local healthcare dynamics. IDNs, in a sense, are purpose built to be regionally focused - even the national companies - because they must respond to different market dynamics and payers from state to state and market to market.

 

 

Healthcare Exchanges

The delivery of care isn’t the only area where a focus of localization is important. With the passage of the Affordable Care Act (ACA,) healthcare exchanges have been created in all 50 states, each with their own structures for handling the administration of care.

 

Different states administer the exchanges in different ways. While some are federally administered, others have hybrid models and some are run completely by the state. Furthermore, health insurance premiums vary state to state and market to market, so individual plans are geared towards these local/regional realities.

 

 

Medicaid

Medicaid is yet another facet of the US healthcare system that has implications at the local level. For example, each state has its own waiver requirements, adding to the complexity insurers face. For those insurers invested in Medicaid, there is a significant level of complexity to manage plans on a state by state basis.

 

What Does This Mean for Pharma?

The dynamics of US Healthcare is rapidly changing. With this change comes the need to strategically align the way markets are being analyzed. Specifically, it is important to consider:

  • The balance between national trends with state and local trends
  • How regional, market level systems are reshaping the delivery of care
  • Key considerations and roadblocks that might exist and the community and state levels.

 

Broader Data. Deeper Insights. Smarter Analysis. Get broader data, deeper insights and smarter analysis in the following areas:

  • US Payers—private insurers, pharmacy benefit managers, employers, benefit designs & formulary, government plans (CMS), including patients enrolled
  • Providers—locations, facilities, specialties, affiliations
  • Healthcare Organizations—affiliations, hospitals, systems, integrated delivery networks, accountable care contracts
  • Patients—over time, across geographies, and spanning claims and EHR

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