Segmenting the Market
Most of this file is copied from the HMA report linked below 👇
HMA_VBP-Entity-Landscape-Report_1.25.2024-final (4).pdf
The primary way this sector is segmented is by value-based payment enablers or risk bearing delivery organizations (aka enabler or med group). Options for segmenting the market further include categorizing organizations based on their target populations, contracted payer types and payment models, scope of services, ownership, and more.
Business model: enabler vs. provider
- Value-based payment enablers (aka enablers): These organizations are not involved in the direct provision of care but have business models centered on partnerships with external providers to assist them in adopting value-based arrangements with public and private payers by supplying technology, supporting change management, negotiating contracts, and more.
- Risk bearing delivery organization (aka med groups): Rather than incrementally transitioning from FFS, these entities are designed to directly deliver value-based care, often assuming global risk for the total cost of care of select high-needs populations.
- Hybrids: Given the similar strengths and capabilities needed to support providers in succeeding under accountable care* regardless of whether they are owned or affiliated, some organizations pursue both business models.
Provider focus: primary vs. specialty
- Primary care-focused entities largely serve primary care clinicians and practices. The best way to distinguish between primary care- and specialty care-focused entities is that primary care entities assume responsibility for the total cost and quality of care for general populations.
- Specialty-focused entities have a relatively narrow focus on a select specialty area. Entities in this segment also assume responsibility for the total cost and quality of care but typically for select subpopulations or conditions.
Two different types of hybrid primary + specialty entities:
- Primary + specialty: Broader than those narrowly defined by a specific disease state/diagnosis but have greater and different clinical needs than the general population (PCPs and specialists work hand-in-hand)
- Primary / specialty: Discrete primary care-focused offerings/service lines for general populations, as well as specialty-focused offerings for specialty populations (specialists work separately from PCPs)
Prioritization of Providers and Geographies
Organizations focused on primary care, whether through enablement partnerships or acquisition, reported using similar general criteria for “tier 1” primary care practices, which include:
- Large and mid-size independent primary care practices, as well as majority-PCP multi-specialty groups
- Serving large and growing Medicare populations, including both FFS and MA beneficiaries
- Some experience in VBP or a cultural alignment with value
“Tier 1” Geographic markets are focused on: