This paper explores opportunities states could consider to improve their Medicaid programs, both to control spending and improve the program's performance.
Employers are showing increasing interest in new payment, delivery, and funding models. To capture the opportunity, payors must be able to target appropriate employers; educate employers, employees, and brokers; and demonstrate savings.
A wide range of changes to stabilize the individual market have been proposed. This special report examines the impact some of the initiatives could have on claims costs and enrollment by the uninsured.
This new framework can help states improve their ability to design and contract for managed Medicaid programs for these individuals—and maximize the programs’ likelihood of success.
Four fundamental forces (risk, technology, regulation, and consumerism) are disrupting the overall trillion-euros-in-revenue global private health insurance market—a market experiencing substantial growth. Private payors must act on the imperatives resulting from these forces if they are to capitalize on the opportunities and avoid obsolescence.
The findings in this Intelligence Brief provide an introductory perspective on how the next US administration and Congressional Republicans may approach altering the ACA and related legislation. The information is based on publicly reported information released through December 8, 2016. Our Reform Center team is continuing to refresh this perspective on a real-time basis and is closely analyzing potential implications and economic impacts for each policy element under a full range of scenarios.
Two steps—increasing healthcare-sector productivity and improving healthcare-market functioning to better balance the supply of and demand for health services—would likely produce sufficient savings to lower medical cost inflation to the rate of GDP growth.
M&A remains an important option for health systems, but targets and strategies are shifting. While traditional economies of scale will continue to be a strong stimulus for M&A, providers will likely seek and achieve value creation much differently in the future.
Traditional arguments for EHR implementation such as efficiency gains and meaningful-use incentives are insufficient to maximize a health system’s returns on its technology investments. However, clinically and operationally oriented sources of value can generate an additional $10,000 to $20,000 per bed in annual margin.
Changes in provider economics are requiring them to rethink their sustainable valuable propositions. Here’s how.
Many health systems are considering launching health plans, assuming that because they can deliver efficient, outstanding care and superior customer service, they will succeed with a health plan. This assumption is not always correct.
By offering its own health plan, a hospital system may be able to gain a variety of advantages -- but the move is not without risks.
Three primary ways in which cybersecurity affects enterprises - and the healthcare industry, in particular.
Insights from our international survey can help healthcare organizations plan their next moves in the journey toward full digitization.
The healthcare industry is on the brink of sweeping change. The experience of other industries that have faced disruption suggests that a new set of winners and losers will emerge. Our research into these other industries reveals three approaches incumbents can use to thrive during and after a disruption.
We believe the payor industry has entered a period of discontinuous change. Traditionally steeped in slow cycles of annual group sales and multiyear product development, payors in today's market must significantly transform themselves in order to thrive.
Payors today must carefully select which markets to focus on—both within health insurance and in adjacent businesses. To determine this, they need insights into where growth and margin can be earned, the foresight to determine when market inflection points might happen, a clear view of their competitive advantages and capabilities, the fortitude to make tough resource allocation decisions, and the agility to alter course as the market shifts.
Historically, larger scale has offered hospital systems a number of advantages; however, reform and other market changes are altering the scale equation for hospital systems.
Whether scale brings competitive advantage to payors is a topic of hot debate. This post challenges standard assumptions about scale and sheds light on how to achieve desired value.
The power of where-to-compete decisions in the health insurance industry is enormous. How can organizations reap greatest benefit from these critical decision points?
This video highlights the variability of reform and the range of potential outcomes for payors.
For most health systems, the one-time impact of expanded insurance coverage on utilization will be small but significant. Systems that can capture a substantial share of the increase in utilization may gain a competitive advantage.
This series of articles examines transformational imperatives specific to health systems in the post-reform era, drawing on extensive work with healthcare stakeholders across the value chain.
This paper outlines five broad changes in the U.S. healthcare system and the likely strategic responses across the value chain.
All signs point to a more specialized future for US hospitals. But getting from here to there won’t be easy.