Healthcare microeconomics (the evaluation of economic incentives within the healthcare delivery system) has been a focus of QPS's Founder ever since practicing in both the UK and US health systems, with their markedly different economic structures. A detailed analysis of potential "winners" and "losers" in the microeconomy, and defined strategies to identify and leverage "winners" is a central component of any integrated business plan.

Microeconomic drivers

  • Top level: Large stakeholders incentivized to keep costs low
    • Insurers (and the ultimate payers) prefer simpler options in an outpatient setting
    • Hospitals generally want volume, but need cost control for each admission
    • PCP margins are low; use of lower cost providers enhances profitability
  • Second level: Stakeholders incentivized to drive profits
    • Hospitals push complex procedures in "Centers of Excellence" to drive profit, while balancing an excess of capacity
    • Providers utilize their control to shift from low-profit to high-profit procedures (e.g., shifting to locations with a reimbursable facility fee, moving to an injectable drug with an administration fee)
  • Third level: Stakeholders incentivized to drive volume, maintain status-quo
    • "No disease goes untreated" – although treatment may be suboptimal. Most patients are offered something, and novel therapies will undermine someone's income stream

The importance of... an integrated plan