EP172: The Convergence of Payers and Providers - A Critical Step Forward, Fraught With Challenges, With John Moore, CEO and Founder of Chilmark Research
March 01, 2018
172
33:46

EP172: The Convergence of Payers and Providers - A Critical Step Forward, Fraught With Challenges, With John Moore, CEO and Founder of Chilmark Research

John Moore, is CEO of the health care IT analyst firm, Chilmark Research, which he founded in 2007. Chilmark Research was founded on the simple premise of conducting the best research possible that will ultimately lead to improvements in the quality of care a patient receives. Having spent many years in other industry sectors, Moore has seen the dramatic improvements possible through effective adoption and use of IT and is convinced that the same can occur in health care.

A core thesis for Chilmark Research is to help guide the industry in specific subsectors of the health IT landscape by focusing on those technology domains that will be truly transformational to the delivery of care. Current areas of research include: analytics, care management and coordination, interoperability, population health management, engagement, and most recently provider-payer convergence.

Prior to founding Chilmark Research, Moore led a diverse worldwide team at Dassault Systèmes, based in Paris. As head of corporate, worldwide industry and market intelligence, he worked with the executive leadership to define key global market opportunities, forecast growth, and develop critical paths to market for its numerous software products.

Moore has held a number of other senior positions during his career including: SVP at analyst firm ARC Advisory Group; Research Associate at MIT; VP of Marketing for an analytical instrument company; and policy analyst for the Commonwealth of Massachusetts. An accomplished speaker, Moore has made numerous presentations on current and future IT trends and their impact to markets. Widely quoted in numerous publications, he has also been interviewed by: AMA News, CIO, CNBC, Computerworld, eWeek, Health Data Management, HealthIT News, InformationWeek, Investors Business Daily, US News & World Report, The Washington Post, and The Wall Street Journal.


00:00 Convergence and the delivery of health care.
02:20 “How do we deliver greater value?”
03:00 Why establishing health plans within a provider organization is often not the best idea.
04:30 How you can get around needing prior authorization and subsequently cut costs.
05:50 The motivation for a payer and provider to form a partnership.
08:00 Why consolidation doesn’t necessarily drive down costs.
08:50 Payer-provider population health management.
09:20 Understanding where the patient might be going outside of the network to get their health care.
10:00 What does it take to be good at collaboration?
10:30 “What is the opportunity here?”
10:40 “Is there a level of trust between the payer and provider?”
18:00 Advice for payers looking to partner with providers.
18:50 Look for someone wanting to deliver high-value care.
19:30 “Trust, then verify.”
23:00 New and interesting innovations coming out of current convergences.
24:00 Things still being worked out in the market today.
25:25 The innovator’s dilemma.
26:30 “How do you scale quickly?”
27:20 “Is that scalable?”
30:20 The path forward for most markets in the United States.
31:45 What Chilmark Research is and does.
32:45 Learn more by going to chilmarkresearch.com and find a free copy of the 2017 Healthcare Analytics Market Trends Report during March!

healthcare,payers,providers,chilmark research,
|

Episode Support Provided By

Special Thanks to Our 2026 Sustaining Monthly Donors

Kimberly CarlesonDylan YahnBenjamin LightMatt McQuideAnn KempskiSpencer AllenScott TromanhauserMarilyn BartlettSteven ElkinsMatthew Bunte.

Recent Episodes

EP505: The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD
Relentless Health ValueApril 02, 2026
505
44:0240.31 MB

EP505: The Death of the "What Is Value" Guessing Game for Clinical and Plan Decision-Makers Ready to Move On, With Ahilan Sivaganesan, MD

Listen On Your Favorite App Hello, Relentless Tribe. Thank you so much for showing up today. All right … to start, let me lay out the goal of the episode today. This episode is for you if you are a self-funded employer looking to ensure your members are steered and tiered to real high-value care and...

EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs
Relentless Health ValueMarch 26, 2026
504
33:3630.76 MB

EP504: A Back-to-Basics Roadmap Through the Perverse Incentives to Advanced Primary Care, With Ryan Jacobs

Listen On Your Favorite App It's been a while since we started from the beginning, so let's just take stock of the basics in this show, refresh ourselves if you're a longtime listener, or welcome if you're new around here. Today we are digging on and about what I would call the poster child for prov...

INBW46: Relentless Tribe Goings-On With Insights to Outwit the Hot Mess of the Non-Healthcare Market
Relentless Health ValueMarch 19, 202619:3717.96 MB

INBW46: Relentless Tribe Goings-On With Insights to Outwit the Hot Mess of the Non-Healthcare Market

Listen On Your Favorite App This inbetweenisode I wanna try something new for two reasons. One of them is that I need to check this episode off my to-do list because I am crushed for time. I'm going to be headed to Arizona tomorrow for the Collective Health Conference , which will have occurred thre...

EP503: Let's Go From Lazy PPO Networks to Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky
Relentless Health ValueMarch 12, 2026
503
46:1642.35 MB

EP503: Let's Go From Lazy PPO Networks to Smart Collaboration With Direct-to-Employer Specialty Care, With Ryan Wells; Leo Spector, MD, MBA; and Adam Stavisky

Listen On Your Favorite App Today we are digging into something I've said probably way too often: Collaboration is the next breakthrough innovation. And I'm doubling down on this because in the current healthcare landscape, two parties that actually should be talking—like burning up the phone wires ...

EP502: How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut
Relentless Health ValueMarch 05, 2026
502
38:5835.67 MB

EP502: How Some Pretty Wild Medicare Fraud Sabotages ACOs and Also Independent Practices and Could Cost Plan Sponsors Such as Self-insured Employers a Lot of Zeros Downstream, With Brian Machut

You know, I always kind of wondered what the hackers were doing with all of the medical data that they've managed to get their mitts on over the past, I don't know, however many years. Now, I know at least one thing. If you're a hacker, you can use your stolen medical data to not actually send wildl...

EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD
Relentless Health ValueFebruary 26, 2026
501
39:5736.57 MB

EP501: Speaking of Infusions, Do You Want to Pay $135 or Do You Want to Pay $13,560 for the Exact Same Drug? With Ivana Krajcinovic, PhD

Let us chat about today the inches all around us and also about how there is no market in healthcare all at once in this show. Today I am talking with Ivana Krajcinovic. And let me give you some examples of the inches. Two members of a plan get infusions at a hospital. And if these two members had g...

Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD
Relentless Health ValueFebruary 19, 202634:5231.91 MB

Take Two: EP398: Why Are Commercial Carrier Marketplaces Completely Boring? Maybe Because There Isn't a Marketplace, With Jacob Asher, MD

We have been doing a little series called "The Inches Are All Around Us," digging out waste in the $5.6 trillion healthcare sector where half an inch of waste can equal billions of dollars. I'm going to right now introduce another series that is complementary but has a slightly different focus. And ...

Listen and Follow

Sponsored by Aventria Health Group
©2026 BD Bridges LLC. All Rights Reserved.