May 8, 2012
With or without health care reform, the challenge for most specialist organizations (whether you focus on mental health, cardiology, or dermatology) is creating a new strategy for a world that is increasingly focused on integrated care.
The data that are driving payers’ preference for integrated care models are pretty clear – a small amount of the population uses most of the U.S. health care resources. 5% of U.S. population—those with multiple chronic conditions —accounts for half (49 percent) of health care spending (see Five Percent of Americans Responsible for Half of U.S. Health Spending ). And, consumers with chronic medical conditions and a mental illness or addiction cost much more than others (see Costs of Complex Consumers Dominate Health Policy Concerns ).
It is this data that is causing payers to rethink their strategies – and develop integrated care management strategies (health homes, integrated disease management models, and more) for that 5% of the population with the greatest resource use. The question is – how do you frame a specialist strategy in an integrated world?
Part of the answer to that question is to understand market segmentation – develop a strategy that is specific to the two emerging segments of consumers. The one-size-fits-all strategy of specialists in years previous doesn’t fit the emerging market models. Rather, the population is separating into two distinct populations (see The Marketing Challenge Of The 5% & The 95% all members), with two different care integration models.
For the consumers without multiple chronic conditions and complex support needs (the 95% market, service integration will be an outgrowth of consumer preference for convenience, control of how their dollars are being spent and consumer-directed health plan models. The result will be more primary care medical home models.
For the intensive, expensive 5% of consumers, payers are leaning toward investments in disease-state management that are coupled with primary care delivery models.
The challenge for most specialist organizations is to focus on one of these market segments – and probably specific consumer needs within the segment – and develop a sustainable strategy in this new context. I don’t think we yet know what model will be the market “winner” for either segment. What we do know is that organizational strategy (and a resulting new service system design) based on market segmentation is a key to a sustainable future.
Monica E. Oss
Chief Executive Officer, OPEN MINDS
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