WorkCompWire’s Leaders’ Speak column features a two-parter from Jack Bailey, of Bailey Southwell. He has worked on a lot of transactions in our space and knows a lot about making deals.

Joe Paduda

Bailey’s point about the growing importance of technology, and specifically the need for accreditation around cybersecurity, is dead on. His other thoughts on the importance of execution and customer service are as well.

I do have a different perspective on one of his statements:

Trend Away from Monoline Vendors to Integrated Service Offerings: While this isn’t necessarily a new concept in the industry, payers increasingly emphasize the benefits of having multiple service lines handled by a single vendor in their contract decisions. As an example, see the quote from the recent quarterly earnings call of publicly-traded industry vendor: "… singularly focused vendors are quickly becoming obsolete while payers recognize a greater efficiency and effectiveness of integrated services."

Two points here.

First, outside of the quote — which I’ll get to in a minute — I don’t see any supporting evidence for this assertion. OneCall is the best example of a diversified service provider, and we all know how that experiment has worked out.

It hasn’t.

In contrast, single-focused vendors such as bill review firm Conduent, physical medicine management company MedRisk (HSA consulting client), DME/Home Health provider HomeCare Connect and PBMs (most of which focus almost entirely on pharmacy) are doing well.

Conduent and MedRisk are the largest providers in their business sectors, HomeCare Connect is growing rapidly, and PBMs myMatrixx (HSA consulting client) and Optum now dominate the work comp pharmacy business.

There are many reasons for this — which I’ve explored in past posts in mind-numbing detail — but the core issue is the same as in any other industry: Doing one thing really, really well is hard enough. Doing several things really well is damn near impossible.

As Bailey noted, payers are demanding excellence in execution and customer service, demands that have (with rare exceptions) not been met by diversified service providers.

Point two: The quote in Bailey’s piece comes from CorVel CEO Gordon Clemons. Of course Clemons would say that integrated services are the bee’s knees; CorVel’s business model is predicated on getting as many dollars from its customers as possible.

Supporting evidence for my contention that single-focus companies are doing well, and are very attractive to investors, is everywhere.

For example, SUNZ’s purchase of case management company Ascential Care, and Mitchell’s acquisition of physician adviser/peer review/IME firm MCN. Both Ascential and MCN were founder-owned and had narrowly focused businesses; they weren’t diversified.

Then there’s Paradigm’s acquisition of Adva-Net for about $110 million, a transaction completed in the last month or so. Adva-Net was also founder-owned (with some venture capital as well) and narrowly focused; it brings a network of pain management providers and facilities to the table.

This follows Paradigm’s purchase of Foresight Medical last year. As I said last September, “Foresight’s niche is narrow but important — the company’s core business is negotiating prices for implantable surgical devices.”

Finally, in all my conversations with larger work comp payers, the vast majority of buyers want best-in-class services — because their customers expect and demand it. SVPs of claims, VPs of medical management, chief medical officers — I’ve never heard one say, “I’ll take mediocre service levels and results because working with one vendor makes my life easier and is less burden on my department.”

Yes, there are exceptions, primarily for smaller payers that don’t have the staff or resources to handle multiple relationships. In that case, the “multi-offering supplier” approach makes sense, and this can be an attractive niche, with vendors building attractive businesses around wide service offerings.

What does this mean for you?

Market segmentation is key. Understand what your buyers’ problem is, and solve it. Larger payers want best-in-class, and many smaller payers are looking for simplicity.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers. This column is republished with his permission from his Managed Care Matters blog.