Washington, D.C. | District of Columbia | 2019 | Market Overview

Washington, D.C., is a challenging market for payers and providers. The Maryland portion of the market has embraced payment reform with an all-payer model that puts hospitals at risk and sets standard reimbursement rates. Maryland’s model constraints cost increases and encourages innovative programs. Meanwhile, in northern Virginia, there are strong clinically integrated networks that use provider incentives to improve quality, but physicians are resistant to full-risk reimbursement models. The district, meanwhile, has struggling safety-net facilities that need expensive modernization and a higher Medicaid population than the surrounding states. Payers maintain influence across the market, and integrated delivery networks also exert control. Look for payers and providers to stick with proven generics to manage costs but also consider new, branded drugs that offer proven outcomes.

Login to access report