Executive Insights

Volume XIX, Issue 69 | November 4, 2017 | By: Bill Frack, Andrew Garibaldi

Through over-reimbursement and under-reimbursement, Medicare Advantage — the first real “retail” health insurance market of scale — has consistently penetrated the Medicare marketplace over the past 20 years. This Executive Insights looks at factors behind the continued growth Medicare Advantage enrollment.

Healthcare Spotlight | August 23, 2017 | By: Kevin Grabenstatter States of chronic pain Intermountain total patients by type and variable cost* by patient type (2014) Average total costs incurred* for pain vs. no-pain patients among DRG** and ICD9^ procedure codes (2014)

The CDC estimates that nearly 80 people die of opioid overdose each day in the United States. Opioid overuse is a critical issue, and the need for interventions is becoming an urgent priority for many health systems. In this Executive Insights, we review how L.E.K. Consulting worked with Utah-based Intermountain Healthcare to develop a comprehensive pain management strategy.

Volume XIX, Issue 53 | August 16, 2017 | By: Harsha Madannavar, Todd Clark, Joseph Johnson

Most data-driven healthcare IT (HCIT) providers aren’t going to survive. Their business models are at serious risk of failure in the next three to five years. To beat those odds, they need to evolve dramatically, and fast, to a point where they are not selling data at all. This Executive Insights examines ways that data providers are making the move from data provider to data analytics services.

Volume XIX, Issue 43 | July 10, 2017 | By: Ben Faircloth Global pharmaceutical R&D expenditure Pharma spending on clinical CROs Trends in tech-enabled service providers

In this Executive Insights, L.E.K. Consulting explores how the use of technology to increase efficiency and enhance quality is transforming the pharma sector. The challenge will be to determine the most effective route to offer truly differentiated services.

Volume XIX, Issue 41 | June 29, 2017 | By: Arnaud Sergent, Serge Hovsepian Value of the French homecare market Changes to tariffs and reimbursement levels A range of prescribing physicians and caregivers influence a patient’s treatment options Larger agencies achieve economies of scale and higher EBIT margins

In this Executive Insights, L.E.K. Consulting examines how homecare providers can address pressure to reduce healthcare costs while maintaining profitability by consolidating local market share in their core segments and improving operational efficiencies.

Volume XIX, Issue 35 | June 6, 2017 | By: Todd Clark 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.