Topic Strategy

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Potential impact of individual market reforms

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.

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Next-generation contracting: Managed Medicaid for individuals with special or supportive care needs

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.

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Global private payors: A trillion-euro growth industry

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.

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Navigating the uncertainty of potential ACA ‘repeal and replace’: A preliminary analysis

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.

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The next imperatives for US healthcare

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.

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Provider scale strategies: The evolving landscape

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.

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Achieving ROI from EHRs: Actionable insights that can transform care delivery

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.

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Evolution of provider economics and identity

Changes in provider economics are requiring them to rethink their sustainable valuable propositions. Here’s how.

Short take

Should providers launch health plans?

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.

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Provider-led health plans: The next frontier—or the 1990s all over again?

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.

Short take

Risk and responsibility in a hyperconnected world

Three primary ways in which cybersecurity affects enterprises - and the healthcare industry, in particular.

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Healthcare’s digital future

Insights from our international survey can help healthcare organizations plan their next moves in the journey toward full digitization.

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Thriving under disruption: How to succeed in the years ahead

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.

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The payor industry in an era of discontinuous change

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.

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Where to compete in a post-reform world

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.

Short take

When M&A is not the best option for hospitals

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.

Short take

Bigger may not be better: Does scale matter for payors?

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.

Short take

Where to compete in a post-reform world

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?

Multimedia

Strategy Matters: Insights in Healthcare (Video, Part 1)

This video discusses reform and the unprecedented change underway for payors.

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Strategy Matters: Insights in Healthcare (Video, Part 2)

This video highlights the variability of reform and the range of potential outcomes for payors.

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The impact of expanded coverage on hospital utilization

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.

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The post-reform health system: Meeting the challenges ahead

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.

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Cross currents in the health economy

This paper outlines five broad changes in the U.S. healthcare system and the likely strategic responses across the value chain.

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Service-line strategies for US hospitals

All signs point to a more specialized future for US hospitals. But getting from here to there won’t be easy.