如何进行细分市场分析MicromarketAnalysis.ppt

CLE MicromarketHOWTOGUIDE MicromarketAnalysisHow to Guide CONFIDENTIAL Thisreportissolelyfortheuseofclientpersonnel Nopartofitmaybecirculated quoted orreproducedfordistributionoutsidetheclientorganizationwithoutpriorwrittenapprovalfromMcKinseyitisnotacompleterecordofthediscussion TaraHahn CLFrankKochenash PTPratKumar ATTonyUeber PT Practicedevelopmentdocument June2005 CLE MicromarketHOWTOGUIDE 1 PLANSCANDEVELOPWINNINGPROVIDERSTRATEGIESBYANALYZINGMICROMARKETS Source IrvingLevinAssociates TheComparativePerformanceofU S Hospitals TheSourcebook2005 ProvidershaveconsolidatedinmanyMSAs Market14 Market16 Market13 Market15 Amicromarketbasedapproach RevealsthemostcompetitivecontractingstrategiesIdentifieskeyprovidersneededtomakeanetworkviableEnablestailoringofcaremanagementtoolstomaximizetheireffectivenessOptimizesspendinglevelsformarketingandcontracting butcaredeliveryhappenswithinsmallergeographicboundaries SeventeenmicromarketswereidentifiedbyanalyzinghospitalreferralpatternsbyzipcodeDespiteoveralldominantMSAshare largeintegrateddeliverysystemdominatesonly3ofthe17micromarkets EXAMPLE Market9 Market8 Market12 Market10 Market11 Market6 Market7 Market5 Market4 Market3 Market2 CLE MicromarketHOWTOGUIDE 2 PLANSSHOULDCATEGORIZEEACHMICROMARKETBYLEVELOFPROVIDERCONSOLIDATION MicromarketscategorizedbyHerfindalindex RelativePhysicianconcentration Physiciandominated Fragmented Consolidated Payor Marketshaper Providerdominated Considerrisk sharing gain sharingagreementsFacilitateintroductionofnewhospital physiciancapacity Considerclosepartnerships narrownetworkproductswithkeyhospitalsFacilitateintroductionofnewphysiciancapacity Tradevolumeforprice PartnerwiththeleadhospitalPartnerwithphysicianstocreateleveragewiththeleadinghospitals CLE MicromarketHOWTOGUIDE 3 RELATIVEPROVIDERCONSOLIDATIONSUGGESTSDIFFERENTPROVIDERSTRATEGIES Network ConsolidatedFragmented FragmentedConsolidated ConsolidatedConsolidated DevelopanarrownetworkChanneltopreferredhospitalsInfluencephysicianreferralpatternsHelppartnersdifferentiateclinicalprograms e g centersofexcellence PickpartnerstomaximizeleverageofnarrownetworkproductProactivelydiscourageconsolidation Partnerwithleadhospitaltoensureindependenceandaccess PartnerwithleadhospitaltoensureindependenceandaccessBepreparedtointroducenewphysiciancapacityIfwilling helpphysiciansoutofcontractsHelphospitalsdefendagainstphysiciancarve out PartnerwithleadphysicianstoensureindependenceandaccessBepreparedtointroducenewphysiciancapacityIfwilling helpphysiciansoutofcontractsBuildanarrownetworkproductaroundhospitalsHelphospitalsdefendagainstphysiciancarveout Contract MaintainadvantagedrateswitheachhospitalUsetheimpliedthreatofexclusionfromnetworkPayforperformance e g medicalmanagement Considergain sharingwithhospitalUtilizepartnershipagreementstosecurelong termcontractsTieratestochangeofownershipclause ConsiderbroaderriskorgainsharingwithhospitalandphysiciansUtilizepartnershipagreementstosecurelong termcontractsTieratestochangeofownership MaintainadvantagedrateswitheachhospitalIntroduceincentive basedpaymentsforphysiciansPartnerwithdominantphysicianstoimprovecostandquality HospitalsPhysicians FragmentedFragmented Thisslideisarepeatofpage42 CLE MicromarketHOWTOGUIDE 4 EXAMPLESOFSUCCESSFULMICROMARKETAPPROACHES Micromarket1 Micromarket2 CLE MicromarketHOWTOGUIDE 5 CLIENTSHAVELEARNEDIMPORTANTLESSONSTHROUGHMICROMARKETANALYSIS PayorscanshareeconomicvaluebyfacilitatinghospitalcapacityconsolidationCountertoconventionalwisdom globalrisksharingmaymakesenseinselectmicromarketsThebeststrategytobalancethemarketpowerofanaggressiveintegrateddeliverysystemisNOTtoout competethemhead to head buttostoptheirprogressinselectmarketsConsolidationofphysiciansincertainspecialties e g Oncology maychangethebalanceofpowerinmanymicromarkets CLE MicromarketHOWTOGUIDE 6 DETAILEDAPPROACHFORMICROMARKETANALYSIS ClassifyDRGsMaphospitalfootprintsbasedonphysicianreferralpatternsCreatepreliminarymicro marketsVerifyboundariesandfinalizemicromarketdefinitions QuantifymarketshareIdentifyclinicalstrengths weaknessesUnderstandout migrationDetermineoperationalandfinancialhealth DeterminelevelofPCPandspecialist e g oncology cardiology orthopaedics consolidationDetermineamount impactofverticalintegration CategorizemicromarketsIdentifyappropriateprovidermanagementtools NetworkContractualCaremanagementChannel physicianstrategyAssigntacticstoeachmicromarkettype DevelopinitialstrategyTestqualitativelywith HospitalsPhysiciansEmployersSubscribersReviseandimplement Customizestrategy toolsforeachmarket Evaluateandupdateproviderstrategy Ataminimum updateoverallcharacterizationevery2 3yearsSignificantmarketplacechangesmaynecessitateadeeperlevelofanalysis Forexample NewclinicalcapabilitiesChangesinownership leadershipCompetitiveactivity CLE MicromarketHOWTOGUIDE 7 SelectcountiesthatdefinetheregionofinterestSelectallacutecarefacilitiesinregionandmaplocationsIdentifytertiaryandquaternarycarehospitalsCollectinpatientadmissiondataoncountiesofinterestSeeExhibitA IdentifyquaternaryDRGsDefinedasaDRGinwhich 50 ofallcasesaretreatedatquaternaryhospitalsIdentifytertiaryDRGsDefinedasaDRGinwhich 50 ofallcasesaretreatedattertiaryandquaternaryhospitalsIdentifynormalDRGsDefinedasallremainingDRGs theseareservicestypicallyperformedatcommunityhospitalsSeeExhibitB UsingnormalDRGsonly determinethenumberofcasesperzipcodetreatedbyeachhospital ExhibitC Createahospitalfootprintbyassigningzipcodestoeachhospital ExhibitD Create2mapsforeachhospitalfootprint ExhibitE 1 Numberofadmissionsperzipcode 2 Marketshareofzipcode MICROMARKETANALYSISWORKPLANDETAIL DEFINEMICROMARKETS CLE MicromarketHOWTOGUIDE 8 MICROMARKETANALYSISWORKPLANDETAIL DEFINEMICROMARKETS CONTINUED Formpreliminarymicromarketsbyoverlayinghospitalfootprints 1 Hospitalfootprintscompletelyenvelopedwithinanother nontertiary hospitalfootprintarepartofthesamemicromarket e g 2 Hospitalfootprintswithsignificantoverlaparepartofthesamemicromarket e g 3 Ifhospitalfootprintsdonotoverlaporonlyoverlapslightly placeinseparatemicromarkets e g HospitalsAandBareinthesamemicromarket definedbyhospitalA sfootprint HospitalsAandBareinthesamemicromarket definedbytheunionofbothhospitalfootprintsForsituationswhereitisunclearwhetherornotthehospitalfootprintoverlapissignificant usethedecisioncriteriaofExhibitFtodetermineifHospitalsAandBareinthesamemicromarket HospitalsA B andCarepartofdifferentmicromarketsTheoverlappingzipcodesbetweenAandBarecontestedzipcodes Seethenextstepforboundaryverification HospitalA HospitalB Micromarketboundary HospitalA HospitalB Micromarketboundary Micromarketboundary Contestedzipcodes A B C CLE MicromarketHOWTOGUIDE 9 MICROMARKETANALYSISWORKPLANDETAIL DEFINEMICROMARKETS CONTINUED Whenitisuncleartowhichmicromarketazipcodebelongs i e acontestedzipcode assignthezipcodebasedonthemarketshareofthehospitalsineachmicromarket e g CreateanoverallmapofthemicromarketsTestmicromarketswithknowledgeof MarketdynamicsGeographicboundaries e g rivers mountains highways railroads etc andrefineasnecessaryIdentifyallremainingzipcodesnotyetassignedtoamicromarket Forunassignedzipcodeswithinamicromarket assigntothatmicromarketForallunassignedzipcodesphysicallyinbetweenothermicromarkets usethesamemethodologyasoutlinedincreatingpreliminaryboundariesMapandnameallmicromarketsSeeExhibitH IfmarketshareofhospitalsA BisgreaterthanthemarketshareofhospitalsC D Einthecontestedzipcode thenassignthecontestedzipcodetomicromarketX elseassignittomicromarketYSeeExhibitGforexample MicromarketY Contestedzipcodes AB C MicromarketX E D X Y CLE MicromarketHOWTOGUIDE 10 MICROMARKETANALYSISWORKPLANDETAIL UNDERSTANDHOSPITALCOMPETITIVEDYNAMICS IdentifythemainhospitalparticipantsinthemicromarketDeterminethemarketsharefornormal tertiary andquaternaryDRGsSeeExhibitI Measuremarketsharefornormalandadvanced DRGsbyspecialtyline Ataminimum analyzeforcardiology oncology orthopaedics andopenhearts ListtheclinicalcapabilitiesofeachparticipanthospitalUsemarketshareandclinicalcapabilitiestodeterminestrengthsandweaknessesforeachhospitalSeeExhibitJ AllcasesnottreatedatoneofthemainhospitalsinamicromarketareoutmigrationMeasurethenormalDRGoutmigrationbyspecialtylinetodetermineclinicalshortcomingsinthemicromarketMeasuretheadvancedDRGoutmigrationbyspecialtylinetodeterminewhichtertiaryandquaternaryhospitalsarebenefitingfromthemicromarketExhibitJalsodescribesoutmigrationSeeExhibitK AnalyzeavailablefinancialandoperationalstatisticstoassessthehealthandvulnerabilityofthemainhospitalsOperationalmetricsOperatingincomeOccupancyrateBedsFinancialmetricsNetincomeFundbalanceLong termdebt equityDriversofperformancePayorandMedicarereimbursementMarketsharehistoryCMIchangesSeeExhibitLforexamplesofanalyses AdvancedDRGs tertiary quaternaryDRGs OpenheartsdefinedasDRG104 109 CLE MicromarketHOWTOGUIDE 11 MICROMARKETANALYSISWORKPLANDETAIL UNDERSTANDPHYSICIANCOMPETITIVEDYNAMICS ForeachadmissiondeterminethereferringphysicianGroupreferringphysiciansintopracticesCalculatethepercentageofadmissionsoriginatinginthemicromarketthatarereferredbyeachpracticeIdentifythetop7referringpractices ThesearetypicallyPCPpracticesSeeExhibitM Forselectclinicalspecialties e g cardiologyandoncology determinetheattendingphysicianforeachspecialtyadmissionGroupattendingphysiciansintopracticegroupsCalculatethepercentageofspecialty e g cardiology admissionsattendedbyeachpracticeIdentifythetop7attendingpractices ThesearetypicallyspecialistpracticesSeeExhibitMIfnecessary performtheaboveanalysisbutonlyforadmissionstoaparticularhospitalratherthantheentiremicromarket Thisgivesagoodindicationofhowdependentahospital sreferralbaseisonasinglepracticeorphysicianSeeExhibitN Forthereferringphysiciansandattendingphysicianspreviouslyfound determinethefractionofcasestreatedbyphysiciansthatareownedbyanintegrateddeliverysystemSeeExhibitMSummarizephysicianconsolidationontoasinglechartbyplottingthefractionofcasestreatedbythetop2groupsvs thefractiontreatedbyIDSphysiciansSeeExhibitODeterminetheimpactofverticalintegrationonreferralpatternsandoutmigrationSeeExhibitP CLE MicromarketHOWTOGUIDE 12 MICROMARKETANALYSISWORKPLANDETAIL IDENTIFYAPPROPRIATETOOLSFOREACHTYPEOFMICROMARKET CategorizethemicromarketsintotypesbasedontheframeworkandrulesofExhibitQFillthemarketstructurematrixofExhibitQbyplottingtheHerfindahl HirschmanIndex HHI forhospitalconsolidationvs theHHIforphysicianPCPconsolidationThisessentiallydefineswhichparty physicians hospitals orpayors hasthegreatestpowerineachmicromarketFillthecompetitivedynamicsmatrixofExhibitQbyplottingcompetitiveHospital14 smarketshare dis advantageagainsttheotherleadinghospitalofeachmicromarketThecompetitiveintensity population geographic andstabilitylocationdeterminethepriorityandurgencyofactionrequiredineachmicromarket Considernetwork contractual andcaremanagementleversSeeExhibitRforaframeworktoidentifytools SeeExhibitSforvariousdetailsonderivingavailableleversappropriatetoeachmicromarkettype TheHHIforanymarketisthesumofthesquaresofeachparticipant smarketshare WhencalculatingtheHHIconsideranintegrateddeliverysystemasoneentity CLE MicromarketHOWTOGUIDE 13 MICROMARKETANALYSISWORKPLANDETAIL CUSTOMIZESTRATEGY TOOLSFOREACHMICROMARKET Usingavailableleversforthegenerictypeofmicromarket craftastrategythataddressestheuniquecharacteristicsofeachmicromarketDevelopstrategyasasetofhypothesesandtestanalyticallyForexample webelievehospitalXwouldbenefitfromagainsharingarrangementwithhospitalYtotreatcardiovasculardisease Thiswouldyield peryear InterviewhospitaladministratorstoverifyanalysesandtesthypothesesIfnecessary interviewappropriatephysiciansIfnecessary conductmarketresearchonconsumersandinterviewemployers FinalizestrategybasedonfeedbackImplementstrategies CLE MicromarketHOWTOGUIDE 14 ANOTEABOUTOUTPATIENTSERVICES Thisanalysisreliesalmostentirelyuponpubliclyavailablein patientinformationontheassumptionthatoutpatientutilizationtrendswillmimicinpatienttrendsVerifyingthisassumptionisdifficultduetothelackofoutpatientinformationClaimsdataisonesourceofalargeamountofrelativelyrobustoutpatientutilizationdataExhibitTgivesonewaytoaddressthisproblem ExhibitTdefinesspecialtylinesforinpatientandoutpatientservicesbyprimarydiagnosisusingICD 9codes Thisisnotaperfectmethodsince dependingontheclaimsprocess asingleoutpatientvisitmayresultinmultipleclaimsforservicesdoneorservicesperformedinsupportofaspecialtycourseoftreatmentmaynotgetcorrelatedwiththeprimarydiagnosisNevertheless thecodingmethodofExhibitTcanbeusefultodeterminetherelativeproportionsofservicelinebusinesswithinahospitalorsystem ExhibitU CLE MicromarketHOWTOGUIDE 15 Exhibits CLE MicromarketHOWTOGUIDE 16 GEOGRAPHICAREAOFINTEREST Source MapInfo AmericanHospitalDirectory HCIAProfilesofU S Hospitals Areaofinterestis13countiesandallacutecarefacilitiescontainedtherein CLE MicromarketHOWTOGUIDE 17 HOSPITALDISTRIBUTIONOFCASESBYDRG Note DRGclassifiedquaternaryif 50 ofcasesaretreatedatquaternaryhospitals classifiedtertiaryif 50 ofcasesaretreatedattertiaryhospitals elsetheDRGisclassifiedasnormal Numberofadmissions ExhibitB 001 Craniotomy 17X Trauma 002 CraniotomyFor Trauma 17 003 Craniotomy0 17 004 SpinalProcs 005 Extracranial VascularProcs 006 CarpalTunnel Release 007 Periph Cran N OthNSProcCc Typeof Hospital Hospital ofCases ofCases ofCases ofCases ofCases ofCases ofCases Tertiary 49 1 0 16 167 0 11 quaternary 300 28 7 29 156 3 33 quaternary 337 40 0 77 118 3 116 84 22 5 34 113 0 28 77 4 1 11 112 0 7 2 0 0 3 106 0 10 1 0 0 1 86 0 2 1 0 0 7 84 0 1 4 0 0 4 83 0 4 Tertiary 83 7 0 14 82 1 76 8 1 0 0 76 0 10 3 0 0 1 76 0 2 Tertiary 59 11 5 18 74 0 8 4 5 0 2 64 0 7 48 5 1 5 63 0 10 5 1 0 9 61 0 7 6 7 0 4 59 0 7 1 3 0 3 56 0 2 8 1 0 9 44 0 6 0 0 0 0 40 0 3 4 4 0 0 39 0 1 6 1 0 4 39 0 4 5 2 0 0 38 0 1 1 0 0 0 38 0 3 0 0 0 0 32 0 2 2 1 0 0 32 0 0 0 0 0 0 31 0 0 6 2 0 6 26 1 5 1 0 0 1 25 0 0 0 0 0 1 24 0 3 0 0 0 0 22 0 6 2 0 0 0 22 0 9 Tertiary 10 0 170 35 0 0 13 1 0 1 1 0 0 2 Total 1124 154 190 304 2262 10 421 Fractionconcentratedat quaternaryhospitals 57 44 4 35 12 60 35 Fractionconcentratedattertiary hospitals 75 56 96 62 26 70 61 DRGclassification Quaternary Tertiary Tertiary Tertiary Normal Quaternary Tertiary DRG Neurosurgery CLE MicromarketHOWTOGUIDE 18 GEOGRAPHICDISTRIBUTIONOFCASESBYHOSPITAL Note1Thismatrixwillbecompletedforallhospitalsinallzipcodeswithintheregionofinterest Paralleltablesaremadetogiveboththehospitalmarketshareofeachzipcodeaswellasthefractionofthehospital stotalbusinessthatcomesfromeachzipcodeNote2Dependingonthesourcesomehospitaldischargesdonotprovidethepatientzipcodeforprivacyreasons e g psychology AIDS ThisdoesnotinvalidatethedataunlessthereisreasontobelievethatthoseprivacycodedDRGsarepreferentiallytreatedataparticularhospitalSource StateData Numberofadmissions ZipCode Hospital1 Hospital23 MedicalCenter Hospital12 GeneralHospital MemorialHospital Hospital26 HealthCenter Hospital Hospital14A Hospital14B Hospital14C Hospital9 Hospital24 Otherhospitals 157 66 1038 25 22 8 39 994 1771 161 30 33 2 108 31 152 13 4 12 2 1022 76 36 5 13 4 1 1 2 3 1 77 20 149 11 5 12 1 459 13 7 12 14 3 2 2 7 6 4 1 2 1 5 2 3 2 39 18 1237 6 3 1 4 83 34 28 5 11 82 16 2365 11 5 6 105 43 34 10 23 34 23 74 2 5 8 1 60 18 31 47 15 10 2 12 8 23 6 4 2 6 11 4 1 91 29 1 101 27 1026 16 8 1 42 43 51 1 1 6 2 1 2 4 3 28 4 28 16 3 6 9 5 1 1 2 2 5 1 50 13 9 41 22 25 13 19 5 31 10 10 34 23 52 8 16 46 15 23 7 60 16 8 58 29 38 98 62 55 81 2 53 20 1 80 68 31 4 21 5 39 8 28 6 2 117 43 7 2 2 7 4 88 3 2 1 100 8 9 3 1 2 2 2 4 4 6 4 9 allotherzips Hospital CLE MicromarketHOWTOGUIDE 19 25 25 Hospital sshareofzipcode Hospitaladmissionsfromzipcodeaspercentofahospital stotalprivacyadjusted admissions 0 5 6 X ASSIGNINGZIPCODESTOHOSPITALS Patients homezipcodesarenotdisclosedforsomecases e g STDs psychiatriccases abortion Thistypicallyrepresents 10 ofahospital stotalnumberofadmissionNote 1zipcodemaybeassignedtomorethanonehospital hospitalfootprintsmayoverlapsozipcodescanbeassignedtomorethan1hospital tosimplifyanalysisonlyconsiderzipcodeswith 100admissions Assignzipcodetohospital Assignzipcodetohospital Assignzipcodetohospital CLE MicromarketHOWTOGUIDE 20 Source StateData MapInfo Zipcodeswhereeachhospitalgets 100normalDRGadmissions Zipcodeswhereeachhospitalhas 25 marketshareofnormalDRGadmissions Hospital27 Hospital24 Hospital10 CLE MicromarketHOWTOGUIDE 21 Ispopulation A B C 25 A B C Yes No A B Carepartofsamemicromarket Is A B 25 A B Is A C 25 A C Is C B 25 C B A Barepartofsamemicromarket Yes No A Barequestionable A Carepartofsamemicromarket Yes No A Carequestionable C Barepartofsamemicromarket Yes No C Barequestionable A B C A C B UNDERSTANDINGMICROMARKETBOUNDARIES MMA B andCfootprints Inquestionablesituations themicromarketsareprobablyseparate however therelativemarketsharesofeachhospital thecharacterofthecompetition andgeographicconsiderations e g riversandhighways needtobetakenintoaccount CLE MicromarketHOWTOGUIDE 22 EXAMPLEOFCONTESTEDZIPCODES Population Market14 Market13 25 population Market14 Market13 Therefore Market14andMarket13aredifferentmicromarketsMarket14ownsagreatershareofzipcodexxxxx therefore zipcodexxxxxxbecomespartofMarket14micromarket XXXXXisacontestedzipcode Region1micromarket Market13micromarket CLE MicromarketHOWTOGUIDE 23 MAPOFMICROMARKETSINREGIONOFINTEREST Market1 Market14 Market6 Market16 Market7 Market5 Market4 Market3 Market2 Market9 Market12 Market13 Market10 Market11 Market8 Market15 CLE MicromarketHOWTOGUIDE 24 SHAREOFINPATIENTDRGsINMARKET13 Other Hosp10 Quarter naryDRG 100 Percent Accountsfor71 ofHospital10 stotalbusiness Directcostsarethoseassociatedwithprovidingdirectservicestopatients Othermonetarymeasures suchastotalcost revenue orestimatedcontributionmargincanbeusedifavailableSource StateData January December1999 Hosp9 Hosp14 Hosp24 Casevolume Other Hosp10 NormalDRG TertiaryDRG Quarter naryDRG 100 Hosp9 Hosp14 Hosp24 Directcost TotaloutmigrationtoHospital14isworth XXmillionindirectcosts NormalDRG TertiaryDRG CLE MicromarketHOWTOGUIDE 25 HOSPITALSHAREOFCORESPECIALTYDRGs Market14 OB GYNNeona tology Cardi ology Ortho paedics Oncol ogy Neu rology Market13 Hosp24 Hosp9 Hosp10 Hosp1