Health Plan Operations

Focusing on cost, operations, and patients

Numerous challenges and questions have surfaced since implementation of the Affordable Care Act began in 2013, making it difficult for health plans to find solid ground. Continued consolidation and fundamental structural changes to the industry, driven by health care reform, are giving cause for many plan operators to focus as never before on cost containment, efficient operations and, most importantly, patient outcomes.

Bold steps

Many forward-thinking executives are considering innovative new business models that can help maintain positive margins and develop new approaches to patient care, new product offerings, cost reduction, and improved efficiencies. At the same time, they are finding ways to meet stringent new regulatory mandates to increase accountability. Operational excellence is imperative for health plans to help navigate these and other challenges, maintain competitive advantage, and forge ahead with a firm footing.

Many leading health plans and health care organization choose Deloitte’s Health Plan Operations services for our deep understanding of their sectors, including the market forces and regulatory reforms shaping their strategies and operating models.

Health Plan Operations services

  • Business model strategies that address reform and market shifts, opportunities for sustainable revenue growth, cost reduction, increased efficiencies, and improved service quality.
  • Core administration efficiency that helps improve customer approval ratings and lower costs through more efficient billing, claims, customer service processes, and technology.
  • Medical management that can improve care delivery through the use of data analytics tools that provide timely and accurate patient information to providers, care managers, and individuals.

Learn more about Health Plan Operations services

Potential bottom-line benefits

  • Flexibility to address future business needs and evolving customer requirements
  • Enhanced competitive position
  • Compliance with health care reform
  • Reduction of operational inefficiencies
  • Reduction of administrative and medical costs

Operational excellence is imperative for health plans to navigate today's challenges, maintain competitive advantage, and forge ahead with a firm footing.

Meet the leaders

Bill Copeland

Bill Copeland

US Life Sciences & Health Care Industry Leader

Bill, vice chairman of Deloitte LLP, is a 30-year Deloitte veteran and leads the US Life Sciences & Health Care practice. Bill is also Deloitte’s Corporate Citizenship champion for RightStep, Deloitte... More

Jason Girzadas

Jason Girzadas

Principal | Executive Committee

Jason is responsible for Deloitte Consulting's overall client portfolio and industry practices which gives him a unique perspective to help lead and architect cross-industry collaboration for clients.... More