The Top and Bottom of the Payer Market

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Not too long ago we had a conversation internally about the payer market and the rise of “payviders” (health insurers acquiring hospitals and physician groups). Since providers are joined at the hip with payers, we wondered how providers at the proverbial front lines (i.e. ambulatory care) are really feeling about the relationship and where this dynamic market is heading.

From an industry perspective, where do the most impactful (read: largest) payers shine and where are they tarnished (or just plain rusted out)? We found a few surprises. Also, if you do something crazy, like throw three massive “government-owned payers” (Medicare, Medicaid and Tricare) into the same pot as everyone else, what shakes out?

We used our research engagement platform to gather specific data from nearly 800 ambulatory care leaders regarding their most and least favorite payers and specific reasons why.

 

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Favorite (and least favorite) payers among ambulatory providers

No surprises here– but there can be a slight disparity between payers with the most contracts and payers that have the highest favorability rating.

 

Top qualities (and deficiencies) of specific payers

We now know the top reasons that providers become best friends with payers and the reasons they gripe about payers.

Who owns the lion’s share?

The top 10 payers, in contract volume, control a hefty slice (60%) of the contract pie.

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