Another gold rush in the ACA marketplace: Can newer entrants beat out long-standing incumbents?
by Vijay Murugappan, President and CEO Unstable, tumultuous, and profitable? Predictions for the individual health insurance market’s...
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Strategy
Organic Growth
Organic Growth
When evaluating growth opportunities, companies can consider expanding their geographic footprint, entering new segments, or launching differentiated products or services.
Mature, heavily regulated markets create the need for companies to drive growth through innovative offerings.
Emerging Markets
Relatively immature markets that are facing a great deal of expansion due to increased consumer growth or demand.
Established Markets
Long-standing markets with entrenched competitors and stabilised consumer demand.
SUBJECT MATTER EXPERTS
Chris Jones
Partner, Innovation Practice Lead
Over 30 years of experience in leadership, operational and strategy consulting roles across multiple industries, including healthcare, energy, consumer goods and transportation.
M&A
M&A
Companies are looking to M&A to expand their market share and grow delivery and technology capabilities. Significant planning and alignment around M&A strategy, acquisition criteria, and realistic synergies is essential to driving a successful transaction and integration.
We help clients with market scanning and pre- and post-integration planning (we do not perform due diligence or transaction management services)
Cost Economics
Cost Economics
Companies are always examining how to create a sustainable delivery method that enables leading class outcomes for consumers.
Competitive markets requires companies to understand how they can optimize for the best dollar against competitors based on predictions of what they might do.
Examples in Healthcare:
Transparency in Coverage: Stakeholders in healthcare can leverage cost transparency to their advantage in different ways. Health plans can utilize this information to achieve lower rates. Providers can utilize this information to increase their rates.
Network: Health plans must carefully design networks to steer membership towards providers in which they have discounted rates.
Provider: Assessing different reimbursement models and care structures between providers and alternative sites of care can improve overall spend.
Care Management: Care management services can be used to steer patients towards time saving, cost-efficient resources that may lower overall spend and improve health outcomes.
Rx: Pharmacy utilization management and pharmacy unit cost levers can be used to reduce Rx spend.
SUBJECT MATTER EXPERTS
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Larry Williams
Principal, Actuary
Former VP of Actuary with +20 years of experience leading pricing and network actuarial teams for $40B+ companies.
Joshua Pierce
Engagement Manager
Former insurance broker and director of network programs at $40B insurer. Expertise in a value based care broker channel, network design, and health plan operations.
Chris Jones
Partner, Innovation Practice Lead
Over 30 years of experience in leadership, operational and strategy consulting roles across multiple industries, including healthcare, energy, consumer goods and transportation.
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