Over the past few years, US healthcare businesses that have prioritized vertical integration have experienced the strongest growth, and those with a payer at the center that owns or is strongly aligned with traditional pharmacy and provider functions but doesn’t own capital-intensive acute-care facilities have seen the quickest revenue gains, note senior partner Shubham Singhal and coauthors. For these payer-centered capital-light integrated delivery networks, the proportion of revenue from nonpayer businesses has increased to almost half.
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A pair of tree map area pie charts show the payer-centred capital-light integrated healthcare delivery network as a percentage of total premium and revenue. The left tree map represents 2017 and the right tree map represents 2022, broken down by healthcare business types. In 2017, more than 3/4 of the network was health plan businesses, followed by nonretail pharmacy businesses at 15%, provider businesses at 6%, and ~1% was taken up by healthcare services and technology businesses. By 2022, the health plan businesses share had shrunk to just over half, followed by nonretail pharmacy businesses at 32%, provider businesses at 8%, and ~1% taken up by healthcare services and technology businesses. A new delivery network of retail pharmacy businesses comprised 7% of the marketplace.
Source: Company filings; HealthLeaders-InterStudy; KFF; National Association of Insurance Commissioners filings.
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To read the article, see “Value creation through business model innovation in US healthcare,” April 16, 2024.