Opportunities Abound for Healthcare Payers Despite Industry Pressures
Healthcare payers face unprecedented profitability and growth challenges. Spiraling costs remain an unsolved issue, with little freedom to act in one of the world’s most regulated industries.
Reform expands the customer base, but also further constrains payers' economics. Competition is intense, differentiation is difficult, and consumers’ are gaining a more prominent role, while provider consolidation shifts power structures, and incentives remain misaligned.
How can payers shape a sustainable, cost-effective healthcare model that is valuable to consumers, employers and the public sector? And how can payers turn these challenges into new opportunities to thrive?
Payers can be highly successful by excelling on three dimensions:
- Innovate the go-to-market and selling approach: Many employers will revisit their priorities and benefit strategies—how can we gain deep understanding of customers’ evolving needs, better differentiate our products and services, and convey our value proposition with more impact?
- Transform member engagement: Individual consumers will be much more involved in health-insurance choices—how can we better focus on consumers and become trusted advisors to encourage the right behaviors?
- Reform delivery and payment: Containing costs and providing high-quality care cannot be mutually exclusive objectives. Accountable care models may be the solution—how can we make them work and be a win-win for all stakeholders?