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Healthcare Payer Consulting

Overview

L.E.K. has extensive experience advising both private and public-sector payer organizations on revenue growth and realization improvement, product and sales strategy, operations effectiveness, healthcare and G&A cost management and M&A support. We help empower payers to drive change through thoughtful research, clearly articulating and refining the value propositions, and adopting a practical approach to integrating new solutions into the value chain.

In the U.S., we help Managed Commercial, Medicare, and Medicaid health plans and other payers develop and implement innovative strategies to respond to rapidly changing competitive and regulatory dynamics in areas such as care management and care models; health insurance exchanges; healthcare quality; and new program, product, and market development and implementation. We offer unparalleled expertise in addressing the requirements of high-need populations including the dual eligibles.  With managed-care Medicaid plus dual eligibles market expansion approaching $300B in revenue there are tremendous but challenging opportunities to capture.

In Europe, L.E.K. advises private sector organizations that contract with the public sector to deliver superior healthcare services, to help ensure services are cost-effective and results-oriented, with an increasing focus on outcomes.  We also advise in occupational health markets and mixed healthcare economies where private medical insurance (PMI) features strongly.  Within these markets, L.E.K. guides clients to develop mixed funding models that increase exposure to self-pay and PMI models as public funding constraints force patients to contribute to the cost of care.  New financial products propositions targeted at value-based patient cohorts may increase PMI penetration.

Client Issues

Payers need to focus on managing the gap between funding and medical cost while keeping a close eye on the myriad of regulatory-induced scenarios.  Payers are asking us:

  • What is a payer’s role in a future with more government control of margins?  How do we optimize the spread strategically and operationally?
  • How should we shape our network strategy to accommodate the rapidly evolving payer landscape? Is a Kaiser-like model waiting in the wings?
  • As government continues to increase its share, how do we succeed and win in these high-growth segments?
  • Can payers afford to integrate into care?  Can they afford not to?
  • How do payers effectively integrate into care coordination in order to ensure quality outcomes are delivered when the existing provider network is not fully capable?
  • How do they migrate from a business-to-business sales model to one that increasingly becomes consumer-centric and intimate with the member?
  • In the face of a reoriented space, what are the critical capabilities and points of leverage that must be acquired and developed?
  • Where we don’t have the necessary skills, how do we activate our strategy for the future?

Examples of Our Work

To learn more about how we help clients create value, please refer to these additional case examples:

  • Served as principal strategic advisor and implementation architect to leading managed care plan’s development of its government programs business.
  • Developed a migration strategy and plan to implement an integrated delivery system (“virtual Kaiser”) in response to the changing market environment for a multi-regional Medicare Advantage plan.
  • Developed comprehensive turnaround plan and supported implementation of priority strategic initiatives (e.g., enhanced medical management and care management. capabilities, revamped concurrent review and prior authorization processes, etc.) for Medicaid long-term care and Medicare Advantage plans.
  • Evaluated strategic growth opportunities for a leading international health insurance and services group, and identified seven specific areas for detailed assessment.

View additional case examples

Please contact us at healthcare@lek.com for additional information.