A Closer Look at Integrated Health Groups

Integrated Healthcare Groups can be segmented (targeted) based on several criteria/factors such as size, # of hospitals, # of admissions, # of employed HCPs (hospital and community-based), etc. When analyzing IHGs it is also important to assess their true level of integration. Several large IHGs (i.e. Carolinas HS and Novant) have grown rapidly through acquisition however they do not have common systems in place across their network, therefore the level of “integration” is somewhat weak. Conversely IHGs with more established systems (i.e. Kaiser, Geisinger, etc.) have infrastructures in place that position them to drive a high level of control and track, measure and reward performance.

Supporting the level of integration, two additional areas to consider when evaluating IHGs include 1. willingness/ability to assume financial risk and 2. level of control with regard to centralized formulary decisions and compliance. As Pharmaceutical companies focus Account Manager efforts on specific accounts it is recommended that they develop criteria to assess potential partnership opportunities. This could include segmenting customers by their approach to financial risk and their level of control. Analysis will likely reflect that:

1. Several IHGs will score high in both areas and be considered highly integrated IHGs, both clinically and financially. These organizations will effectively utilize technology and EMRs to maximize data sharing and drive standardization. Pharma may want to approach these customers in a way very similar to that of well-established Health Plans, utilizing Managed Markets Account Managers.
2. Many IHGs will score high in one area and low in the other. These evolving IHGs offer great opportunity to be aggressively pursued by a Pharma Managed Markets team, focusing at the C-Suite of the organization where the IHG-level decision makers reside.
   1. A number of IHGs are vertically integrated across a continuum of care and exhibit the ability to control the clinical aspects, however they may have a low-moderate willingness to accept financial risk from payers.
   2. Other IHGs may be looking to accept a higher level of financial risk from payers, however they do not have the infrastructure to provide integrated care across their system. With the proper investment in systems and related infrastructure, these organizations may evolve into IHGs with significant influence and negotiation power.
3. Several IHGs will have great affiliations within their network, however they are not well integrated nor willing to accept financial risk. Pharma may want to employ traditional approaches with these entities, utilizing hospital sales teams.