Sg2 Blog

As part of Sg2’s value-based care (VBC) analysis and market research, we review the quarterly earnings calls from a subset of publicly traded legacy payers and VBC-focused entrants. The summary is designed to highlight emerging trends and dynamics in these closely related industries, especially as they tie to VBC. The following post draws from recently released earnings call transcripts fro...

Health system leaders are facing a new kind of coverage risk. Insurance instability is no longer a background variable in planning—it is a defining feature of the operating environment. Policy changes, rising costs and benefit redesign are reshaping who is insured, how well they are insured and how reliably coverage supports comprehensive care. The result is a growing uncertainty for access,...

Clinically integrated networks (CINs) gained a foothold more than a decade ago amid the backdrop of an unsustainable trajectory for fee-for-service (FFS) health care delivery. CINs could function as a vehicle for value-based care (VBC) models in providing an alternative for clinical and payment model advancement. Since then, CINs have become a cornerstone of care delivery, enabling clinical value ...

Health care organizations have turned the corner on pandemic recovery and are now strongly focused on strategy and investment. Day-to-day operations have stabilized for most. But the industry’s competitive landscape has irrevocably shifted, and the performance gap between the best and worst has widened. Health systems must chart this new territory with less capital, which makes strategy&mdas...

Consumerism in health care must transform to meet changing consumer expectations. Consumers increasingly expect to be at the center of their health journey, yet the industry has lacked the ability to translate a retail-like experience—to the benefit of innovative disrupters. To compete and drive profitability, health systems must acknowledge the transformation in health care driven by compet...

As payers incorporate much-needed financial incentives to advance health equity, provider organizations and clinically integrated networks (CINs) should adopt payer-agnostic approaches for true transformation. Both public and private payers have begun incorporating financial incentives into contracts with providers to advance health equity. The ACO (accountable care organization) Realizing Equity...

Physician referral analytic tools have existed for decades to help health care organizations understand referral patterns, prioritize outreach efforts and monitor progress, and organizations have long considered physician outreach teams as tools to improve leakage and increase revenue. While both of these still hold true today, there is actually more to the story. Leakage from affiliated physician...

As part of Sg2’s value-based care (VBC) analysis and market research, we review the quarterly earnings calls from a subset of publicly traded legacy payers and VBC-focused entrants. The summary is designed to highlight emerging trends and dynamics in these closely related industries, especially as they tie to VBC. The following post draws from recently released earnings call transcripts fro...

The health care industry is facing economic headwinds: surging inflation, pandemic-driven staffing shortages and rising competition from novel disrupters. About half of all hospitals reported a loss in 2022, according to Kaufman Hall, and the outlook for 2023 isn’t much better. Today’s conditions demand a new business model, one that centers on customers first—not products or s...

Many health systems have explored direct-to-employer opportunities at some level in recent years, but there needs to be more traction to show for these efforts. It is no secret that employer-funded commercial health insurance has provided the financial margin for providers, payers, benefits advisers and others in the ecosystem. Despite offerings from new entrants and incumbents designed to help em...