Develop Service Line Strategies
Analyze the Competitive Landscape
Anticipate Future Patient Needs
Identify Sites To Capture Demand
Drive Loyalty Across the Patient Journey
Leverage Price Transparency Insights
Retain Patients in Your Network
Match Provider Supply to Demand
Acquire Commercial Patients
Capture Outpatient Demand
Target High-Value HCPs
Strengthen Provider Networks
We collect and organize the industry’s most comprehensive healthcare datasets.
See demand, supply and yield across the U.S. health economy
Validated Data for 2.9M Practitioners
Episodes of Care for 300M Patients
Negotiated Rates for Any Service at Any Location
Flexible solutions to fit your specific needs and workflow
Free resources to help health economy stakeholders use our products and data
Answer Key Questions in Seconds
Health Economy Survival Strategies
Custom Enterprise-Level Analyses
Product Guides and Feature Releases
Inform Data-Driven Strategies
How We Tackle Technical Problems
Data-Driven Benchmarking Tool
Strategic guidance and commentary from our CEO, Hal Andrews
Annual fact-based analysis of trends shaping the health economy
An essential resource to survive healthcare’s negative-sum game
Develop Service Line Strategies
Analyze the Competitive Landscape
Anticipate Future Patient Needs
Identify Sites To Capture Demand
Drive Loyalty Across the Patient Journey
Leverage Price Transparency Insights
Retain Patients in Your Network
Match Provider Supply to Demand
Acquire Commercial Patients
Capture Outpatient Demand
Target High-Value HCPs
Strengthen Provider Networks
We collect and organize the industry’s most comprehensive healthcare datasets.
See demand, supply and yield across the U.S. health economy
Validated Data for 2.9M Practitioners
Episodes of Care for 300M Patients
Negotiated Rates for Any Service at Any Location
Flexible solutions to fit your specific needs and workflow
Answer Key Questions in Seconds
Custom Enterprise-Level Analyses
Inform Data-Driven Strategies
Free resources to help health economy stakeholders use our products and data
Health Economy Survival Strategies
Product Guides and Feature Releases
How We Tackle Technical Problems
Data-Driven Benchmarking Tool
Strategic guidance and commentary from our CEO, Hal Andrews
Annual fact-based analysis of trends shaping the health economy
An essential resource to survive healthcare’s negative-sum game
Over the last eight weeks, we revisited the key takeaways and provided a detailed overview of the 2024 Health Economy Trends Report.1 Each trend underscores the broader takeaway that the U.S. healthcare system is disproportionately expensive and does not deliver value. This year’s report highlights eight data-driven macro trends that are either intensifying or emerging, revealing the importance of optimizing value, as opposed to maximizing value (Figure 1). Looking to the future, health economy stakeholders who focus on value optimization will establish a competitive advantage.
The U.S. health economy, which is funded in large part by Federal programs, state Medicaid agencies and employer-sponsored health plans represents 45% of the global health economy.2,3 Although healthcare spending increased by more than 50% in the past decade, from $2.8T in 2012 to $4.5T in 2022, health outcomes have remained stagnant or declined. This raises a fundamental question: What is the return on society's massive investment in the U.S. health economy?
In economic terms, value measures the benefit derived from a good or service relative to its cost. For decades, consumer markets have emphasized value, enabling Americans to make informed purchasing decisions based on price, quality and convenience. Consumer-focused enterprises are faced with relentless pressure to offer more value, whether more features for the same price or the same features for a lower price or more features for a lower price. Health economy stakeholders rarely meet this standard.
In healthcare, cost, quality, safety and convenience are core components of value and exist on a continuum, with their relative importance depending on the care context. Quality is less relevant in an ankle X-ray but paramount in a craniotomy.
Although America’s per capita Medicaid spending is higher than any other country’s total per capita health spending, overall health outcomes in the U.S. lag behind comparable Organization for Economic Cooperation and Development (OECD) countries.4 Life expectancy has not improved meaningfully since 2000, has declined since 2019 and remains nearly four years below the average of OECD peers. Rates of obesity, diabetes and behavioral health conditions are at all-time highs, further straining the system and reflecting poor health. These outcomes reveal an unfortunate reality: The U.S. health economy prioritizes revenue generation over value creation.
The U.S. healthcare system operates outside the economic principles of a competitive market. Misaligned incentives lead stakeholders – from providers to life sciences companies – to focus on maximizing revenue, particularly from employer-sponsored Americans, without improving care quality or outcomes. Health plan price transparency offers a pathway to disrupt this “status quo” by introducing unprecedented competition centered on delivering value for money.
Value for money is different than value-based care, which is focused on the allocation of risk within a risk pool, not the reduction of the aggregate cost of the risk pool. In contrast, value for money emphasizes optimizing the relationship between price, quality and outcomes for the ultimate payer – whether it be employers, Federal and state governments or individual Americans. However, value for money remains elusive in the U.S.
To remain viable, health economy stakeholders must shift their focus from maximizing their revenue to optimizing value for their customers. In economic terms, value optimization is distinctly different from value maximization (Figure 2). Optimization involves making the best or most effective use of resources within given constraints, whereas maximization aims for the highest possible outcome without regard to limits.
Health economy stakeholders can deliver value for money to the customer – the employer – in one of three ways:
There is no value for money proposition in offering worse than average quality at any negotiated rate, especially one that is higher than the median market negotiated rate.