Healthcare organizations often rely on market share or service concentration analyses to understand provider dynamics and network reach. A critical first step is to set clear definitions, especially broad ones like “provider.” In this paper, we show the impact that this definition can have on the results of an analysis. For this paper’s discussion, we have applied this reference information to the Milliman MedInsight Emerging Experience claims dataset, focusing specifically on claims from 2022 across all lines of business in a particular state, representing just under 3 million individuals out of the dataset’s 80 million individuals. Without incorporating relevant provider groupings, our analysis identified the following missteps:
- Vastly different characterizations of a region’s market for professional services
- Mischaracterization of the market makeup as a whole
- Misidentification of the major players in the market
- Inability to construct a comprehensive view into a provider group or health system’s full suite of services