Healthcare payers and delivery systems are facing disruptive changes. Cost pressure and healthcare reform has opened the doorway to new ways of doing business. Private payers need to reevaluate how to design products that are still relevant in a rapidly changing environment, build solid relationships with their members, and support providers with care management tools and reimbursement systems that encourage higher quality of care at lower cost. Delivery systems must prepare to take on more responsibility to contain costs while demonstrating continuous improvements in patient outcomes.

Many of the current initiatives healthcare payers and delivery systems are implementing are not new, but there is a greater sense of urgency. They will need to embrace the disruptive changes that are altering the competitive landscape and find new opportunities in both existing and new markets. ExpertActions's work with leading healthcare payers and delivery systems addresses key issues faced by industry players and draws on our cross-sector industry expertise and insights. We work with payers and delivery systems to help them focus on the following areas imperative to their success:

Bending the medical cost curve. Controlling medical costs will require achieving true integrated care, introducing population health management systems and reducing utilization by aligning incentives to encourage the right behaviors among patients/members and clinicians. Designing the organization for integrated care delivery. Healthcare delivery systems must adapt their decision-making processes to integrate care across disparate sites and providers. These companies must identify the highest-value decision opportunities and build enduring behaviors, measures and incentives throughout the organization to deliver better outcomes at lower cost.

  • Improving customer loyalty. Unsustainable cost growth and increasing consumer engagement are changing the behavior of purchasing decision maker throughout the healthcare industry. To find opportunities amid these dramatic shifts in the customer environment, leading healthcare payers and delivery systems are learning new ways to identify their true customers, understand those customers' needs and adapt their offerings to create powerful advocates.
  • Optimizing the portfolio. Both healthcare payers and delivery systems must take a hard look at their assets and investment opportunities in order to achieve full potential of their current and future portfolios. They will also need to make hard choices between efficiency vs. effectiveness and short-term vs. long-term returns.
  • Improving care delivery with healthcare IT. Deploying healthcare information technology strategies, including mobile apps, patient portals or other digital health tools, can also help manage rising medical costs, while improving care delivery, care management and operational transparency.
  • Expanding beyond the core. Adjacent markets, such as new healthcare services, geographies and business models, may offer attractive growth opportunities.
  • A healthcare payer's long-term health strategy: A healthcare payer client with low market share and a portfolio weighted toward declining market segments needed a long-term growth strategy. A full-potential growth plan is underway and account share has already improved.
  • Hospital turnaround stems doctor defections: Our hospital client stemmed the tide of physician defections and turned around financial results by devising a new strategy that focused on strategic market segments.