Organizations in today's health care marketplace are faced with crucial business decisions. On the one hand, rapid developments in key local markets are changing how health-related companies and professionals will organize and operate their businesses or practices in the future. At the same time, reform initiatives at both the state and federal levels may have a significant impact on the rules under which insurers, providers and manufacturers and vendors of health products and services will do business.

To make the right business decisions, these organizations need timely, high quality information. They are asking:

  • How will market changes and health reform initiatives affect my volume of patients or customers and how I get paid?

  • Whom do I compete with and what are those competitors doing?

  • Should I form integrated delivery systems with other entities? How should I choose partners?

Like politics, health care is local. Providers and insurers are trying to decide if and how they should compete in certain local markets. They are asking:

  • How does their market share compare with their competitors? What is the cost structure of competing organizations?

  • How will decisions by health care purchasers affect how providers and health plans deal with each other? How receptive are providers and employers to new entrants in the market?

  • Should providers seek capitation arrangements? How can they evaluate the risk involved?

Manufacturers and vendors of drugs, devices and services are trying to understand how changes in the ways providers are organized and paid affect how they market their products. For example, they need to know whether the decision to use one product or procedure over another will be made by an HMO, an employer, an integrated provider network or an individual practitioner. What will drive those purchasing decisions--measured outcomes? Price alone? How will the growth of HMO Medicaid and Medicare enrollment affect them?

Here are examples of the projects that I've completed since launching my practice in November 1993:

Health Care

  • Blue Cross of Washington and Alaska (BCWA). Working with the actuarial consulting firm of Reden & Anders, helped BCWA to analyze its challenges and opportunities under the health reforms in Washington state and Oregon and to devise business and policy strategies.

  • Illinois Healthcare. Analysis of marketplace issues affecting future business prospects of a possible health plan acquisition. Conducted interviews with key purchasers and tied to information about competitors and local trends.

  • Neighborhood Health Care Network (NHCN). Market analysis for 16 community health centers forming NHCN as a vehicle for contracting with HMOs and providing centralized administrative services; currently serving on board of management services organization.

  • NWNL Health Management Corporation (NHMC). Research on emerging provider networks and new HMOs in developing managed care markets and their potential interest in--and need for--purchasing health plan management services from NHMC. I made the first contact with networks that later became clients of NHMC.

  • Nonprofit Clinic Consortium. Assessment of market challenges and opportunities for Washington, DC, nonprofit clinics seeking to collaborate and configure themselves to deal with changes in Medicaid and publicly supported primary care for underserved populations. The research was supported by the Annie E. Casey Foundation.

  • Oakwood Healthcare System/Michigan Affiliated Providers. Assessment of purchaser perspectives on health benefits, providers and health plans in southeast Michigan for physician-hospital joint venture organizations.

  • SmithKline Beecham, Integrated Healthcare Division. Assessment of trends and issues in two Midwestern states, looking at HMO and hospital market competition, financial performance and developments in provider integration and purchaser initiatives.

  • United States District Court, Northern District of Oklahoma, and Oklahoma Department of Human Services. Evaluation of state management of community services for persons with developmental disabilities and assessment of the likely impact of moving disabled Medicaid recipients into managed care.

  • Local market consultations. I consult with several pharmaceutical manufacturers on strategies in local markets and make presentations to their representatives and managers. I have provided consultations on the Minnesota market to provider groups and to other consultants, such as the Wilkerson Group, the Advisory Board, the Urban Institute, the Center for Studying Health System Change and Price Waterhouse. I have prepared market analyses and expert testimony for clients of the Dorsey & Whitney and Halleland Lewis (formerly Popham Haik) law firms and the Martin Williams and Periscope advertising agencies.



© 2010 Allan Baumgarten. All rights reserved.