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.
What issues will matter for the healthcare industry in the United States through the year and into the 2020s?
McKinsey conducted a national survey to understand the impact of unmet social needs on consumer health outcomes, utilization, and preferences. Given the link between unmet social needs and lower socioeconomic status, respondents for this survey included adult Medicare and Medicaid beneficiaries as well as low-income adults who were uninsured or who had purchased insurance through the individual market.
Although they are often pursued as an approach for vertical integration, their value is not always clearly demonstrated.
At face value, the problem is simple: Getting the right care to the right people at the right cost—but anyone who has touched or worked in the industry knows that it’s a lot more complicated. As part of our series looking at productivity, Dr. Ron Walls, COO at Brigham Health discusses the opportunities to improve healthcare productivity—and the steps that leaders could be taking today to improve healthcare delivery.
The president and CEO of Cincinnati Children’s Hospital explains how social determinants of health (e.g., education, housing, social support) affect children’s health outcomes, and how organizations that invest and intervene early can generate both near- and long-term value.
Why nonhospital-provider segments are primed for growth—and why that matters.
Five lessons to consider when moving beyond your core business
Using advanced analytics and digital capabilities to improve the design and implementation of care management programs can promote better patient outcomes and an improved return on investment (ROI).
In transformations, healthcare providers and payers must attend to their organizational health, not just their short-term performance.
Process automation at scale is now feasible for most payers. When coupled with other next-generation digital tools, we estimate that it may enable many payers to reduce operational costs by up to 30 percent within five years.
Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $350 billion–$410 billion in annual value by 2025.
Ron Kuerbitz, Chief Executive Officer, agilon health, shares his perspective on consolidation of the sector, the role of technology, and what he’s most excited about for the future. He spoke with Neha Patel, Partner, McKinsey & Company in December 2018.
Healthcare is a key component of the US economy, but healthcare spending increases consistently outstrips GDP growth. Improving productivity in healthcare delivery could change this dynamic without harming patient care.
With increasing affordability pressure, finding opportunities to continuously improve performance is critical for healthcare payers.
To aid APM (re)design and support providers and payers in their value-based contracting strategy, this paper highlights seven characteristics that distinguish well-performing APMs from poorly performing models.
Planning for the future of healthcare: A conversation with Penny Wheeler, President and CEO, Allina Health
Penny Wheeler, President and CEO, Allina Health shares her perspective on the importance of partnerships in increasing value and understanding the consumer with Jenny Cordina, Partner, McKinsey and Company in an interview conducted in June 2017.
Technology and payment trends are reshaping the revenue cycle. Providers that want to improve yield must think about revenue cycle management in a whole new way, which we call revenue excellence.
Challenges with access continue to frustrate consumers and stunt health systems’ financial performance. Engaging clinicians and improving productivity are vital to address this dual issue.
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.
Medicaid’s scale and complexity are unprecedented. State Medicaid leaders will need to innovate if they are to develop the capabilities that will enable them to steer their agencies into the future.
Planning for the future of healthcare: a conversation with Benjamin Breier, President and CEO, Kindred Healthcare
Benjamin Breier, President and CEO, Kindred Healthcare shares his perspective on major trends in US healthcare and the value of an integrated approach with Shubham Singhal, Senior Partner, McKinsey and Company.
Ken Burdick, CEO, WellCare shares his perspective on major trends and opportunities in US healthcare with David Nuzum, Senior Partner, McKinsey and Company.
Done well, a recovery phase can be used as a catalyst—or jolt—to move a hospital trust towards a sustainable improvement in performance. Done poorly, it can leave the trust in a “turnaround trap”.
Marc Harrison, President and CEO, Intermountain Healthcare shares his perspective on overcoming challenges and his leadership priorities with Brendan Buescher, Senior Partner, McKinsey and Company.
Recent trends are affecting providers’ revenue cycles and altering how providers should manage those cycles. Basic RCM is no longer enough.
This paper explores opportunities states could consider to improve their Medicaid programs, both to control spending and improve the program's performance.
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.
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.
Beating the odds: Hiring and retaining an RN workforce to optimize patient outcomes and minimize unnecessary expense
Effective workforce management can increase RN retention, reduce absenteeism, and improve patient outcomes and experience. Here's how to get ahead of emerging challenges.
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.
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.
Digital technologies and applications have the potential to markedly enhance a payor’s profits. Leadership from the top is necessary to overcome the organizational resistance to change that can make a digital transformation difficult.
Our experience with clinical operations transformations in more than 200 hospitals across the US and overseas has shown that high performers tend to execute five things well.
An evolved approach to RN staffing, optimizing the nursing skill mix leads to lower costs, improved RN satisfaction and better patient outcomes. Here's how to get from 'here' to 'there.'
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.
Health systems (and health plans) that are serious about transforming themselves must harness the energy of their physicians. To do so, they must develop a true ability to engage physicians effectively.
By giving nurses more control over their work environment and more opportunities for professional advancement, hospitals and health systems can reduce nurse turnover, lower costs, and improve patient care.
Although the ACA may make revenue cycle operations more complex, it also presents an opportunity for providers to improve, excel, and differentiate. By adapting their RCM operations and acquiring new capabilities, providers could open up opportunities to win.
A multiprong approach that puts physicians—and clinical care—at the heart of performance transformation efforts can help hospitals and health systems deliver more financially sustainable, patient-oriented, and physician-friendly care.
Care pathways enable health systems (and other healthcare organizations) to make evidence-based decisions about where to focus improvement efforts.
Innovators—some from developing nations—have found ways to deliver care effectively at significantly lower cost while increasing access and quality.
Better procurement practices can help hospitals achieve rapid supply cost reductions of 20 percent or more and keep future cost escalations under control.