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

Marilyn Bartlett, Kimberly Carleson, Dylan Yahn, Benjamin Light, Matt McQuideAnn Kempski, Spencer Allen, Scott Tromanhauser, 
Steven Elkins, Matthew Bunte, and Lori Smith.

Recent Episodes

EP519: The Current State of Primary Care—Inevitable or Fixable? With Lisa Rosenbaum, MD
Relentless Health ValueJuly 08, 2026
519
40:0036.61 MB

EP519: The Current State of Primary Care—Inevitable or Fixable? With Lisa Rosenbaum, MD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Today, let's start here. Right now, we are watching a very visible exodus of brilliant, consummate primary care (and other, honestly) physicians leaving traditional practice for concierge medicine or otherwise. For a full transcrip...

EP518: How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank
Relentless Health ValueJuly 01, 2026
518
14:2513.2 MB

EP518: How Do You Explain the Difference Between an ASO Vendor and a TPA? With Claire Brockbank

Listen on Your Favorite App Dr. Alex Sommers: Hi. I'm Alex Sommers. I'm president of Astia Health, an advanced direct primary care organization, an emergency medicine and lifestyle medicine physician, as well as a licensed employer health plan advisor from Wisconsin. I'm curious how you explain the ...

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths
Relentless Health ValueJune 24, 2026
517
27:2325.07 MB

EP517: The Business of Prior Auths: The 401-Level Financial Motive Behind Prior Auths

Listen on Your Favorite App Hello, Relentless Health Value Tribe. Welcome to it. So, yeah … last week, I had a great conversation with Ophelia Johnson ( EP516 ) that is a companion show, I would say, to this one. So, listen to that one first. Listen to this one first. You do you. For a full transcri...

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson
Relentless Health ValueJune 17, 202644:0540.35 MB

EP516: GLP-1s and Cash Pay From the Pharma Manufacturer Point of View, With Ophelia Johnson

Listen on Your Favorite App Hello, all you Relentless Tribe members. Welcome to it. Today we have a show that will bend your mind in new directions. And yes, I have a head cold at a very weird time of year. I have trouble apparently doing things like normal people. Anyway, we talk a lot on this podc...

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD
Relentless Health ValueJune 10, 202643:0739.47 MB

EP515: SNF (Skilled Nursing Facility) Fraud—Or Is It Fraud? With Michelle Cera, PhD

Listen on Your Favorite App Hello, all you Relentless Tribe members. Lately, I have been just obsessed with what's hiding in plain sight: the root cause glitches in how American healthcare is built. Not the symptoms now. Not the noise. The actual ground zero. I mean, what we call healthcare in this ...

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor
Relentless Health ValueJune 03, 2026
514
43:4340.02 MB

EP514: Successfully Suing a Health System for Their Anticompetitive Contracts and Also Collecting Damages for Plan Sponsors and Members, With Matt Cantor

Listen on Your Favorite App Hello, all you Relentless Tribe members. This is the third episode in our legal goings-on trifecta, starting with Doug Aldeen in episode 512 covering what amounts to the main reasons plan sponsors wind up suing their brokers or employee benefit consultants. For a full tra...

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

EP513: Revisiting Cunning Anticompetitive Hospital Contracts, With Brennan Bilberry

Listen on Your Favorite App If you are a large employer, union funds broker, fiduciary, or anyone responsible for a health plan that spends half of its dollars on hospital care (which most do), or if you have anything to do with policy or enforcement of policy, yeah … listen this week and next week....

Listen and Follow

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