Healthcare Services Case Studies

The U.K. healthcare landscape has experienced a number of fundamental changes in recent years. L.E.K’s client, a U.K. charity providing end-of-life care, needed to evaluate its strategic choices in response to wide-reaching changes in the National Health Service (NHS) commissioning structure. The new healthcare landscape requires providers to develop increasingly innovative models for care delivery. L.E.K. was engaged to consider how the client should evolve its strategy to enhance cost and operational effectiveness while continuing to deliver high quality care.

The U.K. dentistry market has seen significant growth in recent years, with market value rising substantially in the past decade as spending on both the National Health Service (NHS) and private dental treatment spend has increased. Following its acquisition by a private equity firm, a leading U.K. dental chain engaged L.E.K. to design a new strategic platform with the aim of segmenting its portfolio, improving operational performance and determining expansion opportunities.

Facing an increasingly challenging post-Affordable Care Act (ACA) environment and reimbursement pressure, a world-renowned academic medical center was evaluating a range of strategic options, including whether to vertically integrate and become a health insurance payer. Given L.E.K.’s extensive experience in advising managed care clients, the hospital engaged L.E.K. to assess the provider-sponsored health plan opportunity and develop a market entry plan.

A leading regional hospital system was suffering continual and significant patient volume losses in both inpatient and outpatient procedures, across all service lines, over the previous five years. Profitability was declining, and patients and physicians alike were turning to newly opened hospitals in the region. The hospital system asked L.E.K. to help develop a strategic plan to drive profitable volume through a set of discrete and clearly defined initiatives.

Accountable Care Organizations (ACOs) are one manifestation of a broad-based, ongoing trend to better align incentives for healthcare providers (hospitals, medical groups, integrated delivery networks or IDNs) and enable them to share in the benefits from reduced costs and improved care quality, coordination and outcomes. During the early period of ACO formation, the business services division of a large healthcare services company was developing a comprehensive suite of services for ACOs. Given the nascent stages of ACO formation the company requested assistance to better understand the future of the ACO market to optimize their go-to-market strategy.

A leading, multi-regional, integrated payer-provider was facing a significant, long-term gap between actual and strategic plan performance. The payer-provider required assistance to close the gap within 36 months. L.E.K. was engaged to assist with this company-wide revenue optimization and cost reduction effort. In particular, L.E.K. participated in the effort to catalog all financial performance initiatives, identify and validate incremental initiatives, and assess the feasibility, timing, and risks associated with each initiative.

A confluence of events (regulatory, structural, competitive) has increased pressure on the fundamental economics of many health plans. Under this margin pressure, health plans often view effective care management as a critical lever in ensuring a sustainable economic model. A leading regional health plan engaged L.E.K. to conduct a comprehensive review of their care management and medical management functions in order to identify opportunities for optimization and improvement.

“Dual eligibles” receive both Medicare and Medicaid benefits by virtue of their age or disability and low income. Given the high cost of caring for dual eligibles and their complex needs, the federal government and several state governments have collaborated with private payers and providers to develop innovative managed care programs to more effectively manage dual eligibles’ healthcare needs, increase quality, improve outcomes, and reduce healthcare costs. Against this backdrop, a well-respected health plan with experience in Medicare, but new to Medicaid, engaged L.E.K. to support them in developing a managed care offering for dual eligibles in response to a request for application (RFA) from the state Medicaid agency and Center for Medicare and Medicaid Studies (CMS).

Healthcare reform and its various side-effects dramatically re-shape an employer group’s incentives and options when considering health insurance for its employees. Given this environment, one of the nation’s largest benefit consultancies engaged L.E.K. to independently analyze the nature and magnitude of the private health insurance exchange opportunit

Growing demand for healthcare services is placing an increasing burden on public health systems at a time of fiscal austerity, forcing governments to look at new models to deliver improved healthcare outcomes at lower cost.