WASHINGTON, June 3, 2021 /PRNewswire/ -- Guidehouse, a leading global provider of consulting services to the public and commercial markets, has released its inaugural Center for Health Insights Index in a new report that identifies markets ripe for payviders: risk-based collaborations between payers and providers.

The Greater Detroit, Miami, Phoenix, and Tampa areas were among the markets with the greatest opportunities for payvider adoption and growth, according to the Guidehouse Center for Health Insights Payvider Market Index. These markets represent high value-based growth potential given competitive dynamics and demographic/payer changes, with an opportunity to differentiate value-based payment and delivery operations.

"The rules of the game for delivering high-quality, cost-effective, consumer-centric care are changing, and healthcare organizations are at an inflection point," said Michael Nugent, partner at Guidehouse. "Margin is moving to the beat of the market, risk-based payment, and consumerism. Where an organization is positioned in their market greatly influences their business model. This has created a demand and urgency for payviders, where payers and providers must work in harmonious accountability to succeed."
To help payers and providers broadly understand where they can most effectively uncover opportunities for payvider models, Guidehouse evaluated more than 100 US markets with a population of 500,000 or more based on market size and future growth, as well as current-state value-based payment performance. The Payvider Market Index identified markets that are ripe for payviders, those with potential for greater scale, and those that need the capabilities to better manage risk.

According to the Index, the Greater Minneapolis/St. Paul, Portland/Vancouver, and San Francisco areas were among the markets with the highest performing payviders. These areas can expect further membership growth potential given strong performance and demographic/payer changes, with an opportunity to refine existing value-based payment and delivery operations to retain new members.

"The Centers for Medicare & Medicaid Services is aggressively shifting to managed care as its preferred model and private-equity-backed, tech-enabled disruptors are steering business away from poor performers," said Aimee Sziklai, Guidehouse partner and Commercial Payer leader. "Providers and payers must be prepared to both share risk and understand where market opportunities for risk-sharing exist so that they can compete for members. When done right, payvider models can turn organizations into growth engines that support sustainable margins and better health for all."

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