State and federal stakeholders are sharpening their focus on the dual eligible population. What will it take to improve quality, outcomes, and value for this population?
Topic Commercial group insurance/private payors
This analysis reflects carrier participation, pricing, and plan type trends for the 2020 individual exchange open enrollment period. Findings are across 50 states and DC.
Despite the promise of digitization, paper forms will remain for many years. Payers that find a better way to handle both paper-based and digital information will have a competitive advantage.
Economic ebbs and flows are called “cycles” for a reason. The challenge for healthcare leaders is not whether the next downturn will occur—it’s whether you’re ready for it.
Although end-to-end digital claims management is still a distant vision, much can be gained from digitizing portions of the claims process today.
Survey findings shed light on how social determinants of health affect healthcare utilization rates and consumer interest in social program offerings.
Value networks and value-based payment are usually implemented independently, limiting their effectiveness. Greater alignment of these strategies can allow payers to unlock their transformative potential.
With increasing affordability pressure, finding opportunities to continuously improve performance is critical for healthcare payers.
The journey to a new tomorrow: A conversation with Patrick Conway, MD, President and CEO, Blue Cross and Blue Shield of North Carolina
Patrick Conway, MD, President and CEO, Blue Cross and Blue Shield of North Carolina shares his perspective on embracing challenges and disruptions in healthcare, improving the patient experience, and preparing for the future with Celia Huber, Senior Partner, McKinsey and Company in a June 2018 conversation.
A digital transformation can enable private health insurers in Europe to control costs, attract new customers and retain existing ones, and influence the quality and quantity of delivered care.
Extending the use of episode analytics beyond alternative payment models: A scalable architecture for improving payer performance
Payers (and providers) that have dismissed bundled payments or treated it as a narrow part of their strategies may under-appreciate the value of episode analytics in improving core business functions.
Excellent underwriting capabilities can make possible not only sustained risk taking but also greater efficiency, organizational growth, a better customer experience—and even improved patient health.
Healthcare is a dynamic industry with significant opportunity, but cost concerns, uncertainty, and complexity can also make it an unnerving one. Substantial upside exists for players that can deliver value-creating solutions and thrive under uncertainty.
Growth, major changes, and strong value-creation potential make healthcare an exciting industry. At the same time, uncertainty and complexity make it an unnerving one.
Ken Burdick, CEO, WellCare shares his perspective on major trends and opportunities in US healthcare with David Nuzum, Senior Partner, McKinsey and Company.
In this interview, Otto Bitterli (Chairman of Sanitas Health Insurance) discusses the company’s digital transformation and its commitment to being an innovative long-term partner to its customers.
The odds are stacked against healthcare organizations as they pursue sustained growth and differentiated performance. Six strategies can help them achieve successful transformations at scale.
Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers navigate the changes ahead.
A new concept, organizational agility, can help healthcare companies adapt more quickly to changing customer needs, competitor responses, and regulatory guidelines—without requiring a full-scale restructuring.
Converging trends are disrupting the US healthcare industry. Health insurers are not likely to disappear, however, despite predictions to the contrary. Insurers that can take advantage of these trends are likely to find that their best years are ahead.
To select which markets to focus on—both within health insurance and in adjacent businesses—payors must have strong market insights, the fortitude to make tough decisions, and the agility to alter course rapidly.
In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.
Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites for making value-based care sustainable.
In private health insurance, a focus on technical excellence in product development, pricing, underwriting, and claims handling can improve insurers’ bottom line—while easing their dependence on investment returns.
New McKinsey research shows that changes in health insurance type are a common event for most Americans.
What insights from a large employer survey tell us about the current and future state of employer health benefits.
Businesses know the cost and benefits of every item they buy -- except when it comes to healthcare.
Private exchange enrollment is projected to nearly double in 2014 and could comprise 20% of the employer market by 2019.
While recent attention has focused on public exchanges, the commercial group market will be a hotbed of change over the next five years. Unmanaged, the segment faces profitability pressure, but payors who take proactive measures to redesign their health benefits product portfolio and optimize their pricing approaches will find revenue and earnings growth.