Transform delivery of innovative, affordable and high quality care models through organizational transformation, new partnerships or new business ventures
The care delivery ecosystem is changing rapidly; many new entrants and new models of care are challenging the paradigm around when, where, and how care can be best delivered, with an increasing focus on in-home and virtual settings.
As a result, many healthcare stakeholders are playing bigger roles across the care delivery ecosystem in order to advance transformation of care or defend their positions, stepping outside the bounds of their traditional roles.
As the market shifts, payers are generally considering plays to further influence the provider market (via steerage, and value-based care mechanisms), enable provider partners (via provision of MSO services, care coordination support), and in some cases, directly participate in the landscape (via investment or direct ownership).
Common issues we help our clients solve
How well are our provider incentive programs and partnerships performing today? Where are there opportunities to improve? What are the next wave of enablement and contracting models to consider?
What are the potential ways the provider market may evolve? How can we play a role in that evolution? Where is our competitive position most threatened?
What pockets of our membership have the most opportunity for total cost performance improvement–potentially informing the places we should invest from a care delivery standpoint?
How can we use provider partnership strategies and care delivery approaches to improve or retain our market advantage?
How should we balance the partnership with new vendors and provider assets coming into the market with the need to support and sustain our existing, traditional provider network?
How should we respond to competitors acquiring care delivery assets that become a part of our provider network ecosystem?
What are our options to expand beyond traditional insurance into the care delivery space, and how should we evaluate those options? What are the benefits and risks of each approach including new, non-insurance services/enablement organizations, brick and mortar provider assets, virtual care assets, etc?
1. Medical spend continues to grow steadily (with dip in 2020), but provider profitability is declining
2. Provider consolidation is increasing–accelerated by COVID-19 and economic pressure
3. Virtual channels are improving access to care (e.g., e-consults, use of peripherals for diagnoses), with variability in adoption across specialties
4. Care delivery model is rapidly evolving with new medical technology impacting medical best practices and site of care
5. Non-fee-for-service reimbursement models remain scattered, with no unified, widespread approach
6. Payers continue to emphasize a shift to lower cost sites of care
Enhanced care delivery models must be tailored to address specific opportunity areas to drive improved outcomes.
Purpose-built transactional care (e.g., centers of excellence for transactions) can be applied broadly or specifically applied to serve a broader care models.
High-intensity longitudinal care: Integrated, holistic care for high-acuity members, with cross-constituent coordination and management.
Purpose-built condition management: Models targeting holistic management of specific condition across the health care supply chain.
Purpose-built episode management: End-to-end management of discrete episodes of care (e.g., pre- and post-op care, extending to post-acute facilities).
Virtual-first: Models oriented around virtual solutions that are the primary/dominant channel through which members receive care.
Low-acuity population management: Management of low acuity populations leveraging early detection, low-cost sites of care, and steerage to preferred supply.
Source: Oliver Wyman Analysis
Choose a primary transformation orientation: Determine whether care delivery transformation can be best accomplished through introducing new innovative organizations to the network, partnering with existing ecosystem partners (large independent multi-specialty practices versus clinically integrated health systems), or directly entering through build/buy of care delivery entities (e.g., ASFs, PCPs, clinics, etc.).
Weigh market response: Consider impact to payer brand, consumer trust and provider market abrasion/reaction, balancing the threat of making a move vs. the threat of being moved upon and missing the window of opportunity and letting competitors curate the market.
Consider entity and capital requirements: Understand legal, governance, compliance, regulatory considerations, and capital intensity requirements of various moves.
Create new capabilities and roadmap: Build clinical disciplines to transform care and improve outcomes, evolve the talent and resourcing model, and create the infrastructure and enablement to deliver new care delivery models.
Align on “closed” vs “open” access strategy: Determine whether care delivery transformation efforts would apply to only your members, allowing for a differentiated set of experiences and outcomes, versus opening the model to broader market use to create scale benefits at the risk of “floating all payer boats”.
Oliver Wyman has helped multiple clients develop a comprehensive Care Delivery strategy, weaving together traditional provider partnership plays with new businesses/innovative ventures.
Developed a tangible care delivery strategy with $240M annual potential upside and service of +20% of fully insured members; supported selection of a provider asset partner deemed critical to strategic control. Read more
Developed the strategy to leverage value-based reimbursement and MSO service suite to transform specialist provider groups into high performing care models. Read more
Developed the strategy for entry into care provision and designed the initial business model to do so with 10-12% medical cost savings estimated for the target population. Read more
Assembled cohesive set of home care, virtual care, and provider enablement assets to realize a health plan’s care delivery transformation efforts. Read more
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