Harness the power of the enterprise to analyze, prioritize, and integrate initiatives that will deliver cost and utilization improvements through cohesive and efficient deployment of provider network management, clinical, pharmacy and behavioral health programs, medical policies and product/benefit structures
Health systems and payers are facing greater pressure to find year-over-year medical cost savings due to rising competition from traditional incumbents and new market entrants, which erode customer tolerance for price increase, and increase medical and administrative costs.
Medical Cost Action Planning (MCAP) is the rigorous discipline of monitoring performance and enacting strategies and initiatives to drive affordability.
Successful efforts require cross-enterprise coordination, purposeful application of talent and resources, and robust benchmarking and evaluation analyses.
Common issues we help our clients solve
How can we design an effective Medical Cost Action Planning process and strategy, tailored to our organization, that identifies and drives year-over-year savings in line with our corporate goals?
What are our highest potential cost savings opportunities today?
How can we use analytics to better identify, prioritize, and monitor opportunities? Including:
What is the right set of market, peer comparison, and self-referential benchmarks to understand where we are over/under performing?
What is the process for doing root-cause analysis to uncover savings opportunities?
How do we deploy a rigorous, agile, and efficient process to execute root-cause analysis of cost drivers, ideate solutions, prioritize the most effective cost management lever, successfully deploy and monitor a portfolio of medical cost management solutions?
What is the right MCAP operating model that fits our organization (e.g., centralized vs. decentralized)?
Investment in analytic resources, tools, and methodologies to identify, prioritize, and measure cost savings opportunities.
Multi-year strategy with set goals for where and how to drive meaningful savings.
Continuous discipline to identify, execute, and monitor savings opportunities.
Commitment to review, refine and replace existing affordability focused programs on an ongoing basis.
Organizational buy-in, team structure, and cross-stakeholder participation to identify, design, and execute initiatives to drive savings.
Source: Oliver Wyman analysis
Oliver Wyman has extensive experience helping plans create enterprise Affordability strategies and launch new enterprise MCAP operating models and teams.
Designed and implemented a Medical Cost Action Planning solution design and governance structure to identify savings opportunities and coordinate across the client’s functional teams (finance, actuarial, clinical, Rx, etc.) going forward; identified and prioritized 8 core initiatives with $30M annual savings potential in the MA and ACA lines of business. Read more
Developed a detailed playbook for executing strategy development, ideation, and action planning; worked with enterprise leadership to design and implement a centralized affordability team responsible for strategy development running the day-to-day ideation and action planning. Read more
Performed a diagnosis of root cause drivers of medical cost increases, including Actuarial-led claims analysis, and recommended specific actions to help the plan drive better affordability and maintain leading market position, resulting in 2-7% medical cost reduction over time; enabled launch of a new function and process to perform Medical Cost Action Planning. Read more
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