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Executive Insights

Volume XIX, Issue 35 | June 6, 2017 | By: Todd Clark, Joan Kim Managed care and FFS Medicaid enrollment (2008-2014) State pay-for-performance incentive types States by nature of Medicaid managed care plan pay-for-performance (2016) States implementing managed care payment withhold DC DHCF scoring system to determine distribution of payment incentives Ohio Department of Medicaid scoring system to determine distribution of payment incentives SC Medicaid MCO quality indices, measurement years 2016 and 2017 Common metrics used to evaluate MCO performance in P4P programs

In the midst of the continuing uncertainty related to the “repeal and replace” of the Affordable Care Act (ACA), those with an eye on Medicaid programs are bracing for reduced funding in some form, whether or not they manifest in block (per capita) payments. This Executive Insights examines the range of mechanisms by states to incentivize MCO performance and includes case studies from the District of Columbia, Ohio and South Carolina.

Volume XIX, Issue 25 | April 17, 2017 | By: Bill Frack, Kevin Grabenstatter U.S Surgical Cases Proportion of outpatient surgical cases performed in an ASC Ambulatory surgical centers ownership structure and growth

UnitedHealthcare’s recently announced acquisition of Surgical Care Affiliates (SCA) represents the latest signal that the $30 billion ambulatory surgery center (ASC) segment is moving to the forefront of the rapidly evolving healthcare market. In this Executive Insights, L.E.K. Consulting looks at the various factors favoring further share gains for these value-oriented care facilities.

Volume XIX, Issue 18 | March 8, 2017 | By: Monish Rajpal Outpatient practices: Relative attractiveness for investment Reimbursement sources of key market segments

The ongoing transformation of traditional healthcare has compelled providers to restructure practice locations, medical affiliations and processes in order to maintain profitability without ceding market share, care quality or convenience. In this Executive Insights, we look into current outpatient trends and highlight a number of “hot topic” practices that come up for discussion frequently.

Volume XIX, Issue 13 | February 13, 2017 | By: Jonathan Sparey The U.K. population is ageing and a large cohort will hit retirement in the next 10 years There is growing recognition that the NHS will need to change and that privately funded healthcare will be required 70% of U.K. wealth is controlled by the over 55s People do not consider themselves old and want to live healthier, more active lives further into retirement New models need to focus on consumer-led propositions and delivering value for money to encourage participation

The NHS is part of the fabric of Britain. However, increasing pressures on the system have resulted in an NHS which is now in crisis. Private healthcare providers have the potential to help meet the country’s growing healthcare needs by providing critical and complementary support to core NHS services. This Executive Insights examines the changing nature of the U.K.’s healthcare needs and details five key challenges private providers need to address if they are to become of greater strategic importance.

Analysis 1 | January 25, 2017 | By: Alex Evans, Chris Randall Three categories of consumables Consumables engagement by category and segment (2016) Average spend per customer* in the past month (2016) Share of consumer spend by channel and category Share of foodspend and beverage consumer spend by channel and customer type Price, convenience inform channel choices Channel drivers by age Likelihood to purchase a health & wellness product subscription Willingness to purchase private-label brands, by product segment Overall: Perspectives on private label, by category

The 2016 Health & Wellness Study examines consumer spending preferences for nutritional supplements, personal care and healthy grocery products among Millennials, Gen X and Boomers. The study looks at category engagement, drivers of channel selection and, the potential for subscription services, as well as the success factors for private-label products.

Volume XIX, Issue 1 | January 5, 2017 | By: Clay Heskett, Helen Chen, Peter Rosenorn, David Barrow Four forces driving global healthcare trends Major causes of morbidity Healthcare spend for selected countries (2015 vs. 2018) Across regions, payers are becoming more rigorous at restricting access to medicines

Developing therapeutics and medical devices for global healthcare markets remains a risky proposition. The medical innovations now coming to market are remarkable and reflect the reaction of healthcare companies towards innovation a decade ago. Globally, the biopharma and medtech sectors are being shaped by four significant forces, which will determine the success factors for the next generation of healthcare products. In this Executive Insights, L.E.K. examines each of the key forces driving change.

Volume XVIII, Issue 46 | December 2, 2016 | By: Kevin Grabenstatter, Wiley Bell Healthcare Reform Initiatives

What will the transition to a Trump administration mean for the healthcare industry’s key constituents? While experts of all stripes are asserting predictions, they are typically long on speculation and short on evidence. In a moment of political uncertainty, it is most useful to know which issues and stakeholder “tensions” to watch closely. This Executive Insights will highlight some of these questions.

Volume XVIII, Issue 34 | October 10, 2016 | By: Zafar Momin Growth in incomes and healthcare expenditures for selected SEA and Asian countries (2010-2020F) Growth in middle-class population in SEA Share value index of SEA healthcare sector and selected indices Financial ratios for selected hospitals Financial ratios for selected hospitals

Southeast Asia (SEA) is offers opportunities for private healthcare provider investments in light of increasing demand for private health services that are supported by strong growth fundamentals and the inherent gap in public healthcare infrastructure. This Executive Insights discusses the key challenges and investment outlook.

Volume XVIII, Issue 30 | August 9, 2016 | By: Peter Smith L.E.K.'s Seven Step Dynamic Performance Management Process Metrics that Reflect How the Business Really Works Economic Framework to Model Future Cash Flows Critical KPI Identification KPI Prioritization Matrix Data Capture Process and New Supporting Technologies

There are only a few KPIs which have a large influence on profitability – but defining and understanding how they interact with each other can be difficult. L.E.K. has developed a Dynamic Performance Management tool which can help businesses to address this problem and improve profitability by more than 30%.

Healthcare Spotlight 4 | June 10, 2016 | By: Wiley Bell, Joan Kim, Andrew Garibaldi

Participating in the public health insurance exchanges established by the Affordable Care Act (ACA) has been a tremendous financial strain for most health plans. In this Executive Insights Healthcare Spotlight, we examine how a few profitable exchange plans may yield some insights — and raise key questions — as to how sustainable exchange plans will evolve. What are the lessons for a more sustainable exchange future?

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