Health Plans has been saved
Bringing innovation to an evolving market
In the current environment, health plans face more than an adjustment. They are playing a new role in helping new populations get new kinds of care in new ways. Instead of just changing practices, they may have to embrace new value propositions. Deloitte’s Health Plans practice offers a range of solutions to help organizations make the most of post-reform market opportunities. And our experienced team collaborates with clients to create customized, innovative solutions to meet their unique needs.
The new health insurance market makes competing a two-stage proposition—win consumers on your health plan’s value proposition, but keep them based on the right consumer experience. Because products will become more standardized and consumers are becoming more discerning and informed, price and innovation are the keys to getting them in the door. But because those consumers will have more choices, health plans also have the opportunity to win them as customers for life—initiating, growing, and sustaining profitable relationships.
Investments in security are at an all-time high, yet successful cyber-attacks are still on the rise, both in number and sophistication. And despite heightened attention and unprecedented levels of security investment, the number of cyber incidents—and their associated costs—continues to rise. They typically point to the growing sophistication of hackers and other adversaries as a particularly intractable problem. Some deliberate over whether being secure is even possible in today’s rapidly evolving landscape of cyber. Our Secure. Vigilant. Resilient. approach helps you get ahead of cyber risk, so your business can keep moving forward.
Health Care Regulatory Solutions
Doing business with the government is nothing new for many health plans. But even for the most government-oriented insurers, the game has changed. Medicaid is expanding. Medicare’s population is growing. And health insurance exchanges are live. More government money in the system and compliance with the Affordable Care Act (ACA) mean more government influence as well—and as the government changes its purchase expectations and interactions with plans, plans will likely change not just the amount of business done, but also how it’s done. With our professionals and your team members working side by side, your organization can plan long-term moves to help navigate this changes.
Health care organizations are finding that generating margin is much more difficult in today’s post-reform world. Many are taking a close look at their financial performance, realizing that incremental improvements will not be enough to remain viable. Meanwhile, as organizations consider a range of new strategies and business models to win in the shifting market, they may need strategic flexibility enabled by efficient and lean operations in order to pivot and keep up with changing market demands.
Strategy & M&A
No matter how effective a health plan is today, it may not have the reach or capabilities to remain competitive tomorrow. If you’re like some plans, in particular those that are moderate in size or limited in geographic reach, you’ll need to grow—into new sectors, new service areas, or both. The need to grow doesn’t dictate the way to grow. But purely organic efforts to sell more of the same things to the same people won’t necessarily produce the desired revenue and earnings results.
The fee-for-service (FFS) model as we know it today may be headed for obsolescence. In its absence, plans face a crossroads—enhance positions through new models and collaborations, or risk irrelevance. The shift from volume-based to value-based care isn’t immediate, but the end of FFS in its current form may be inevitable. This change affects everyone in the health care ecosystem. In order to thrive, health plans should consider taking on change early. That means taking the lead in delegating care, driving transparency, aligning incentives, and updating payment models.