MARCIA MaCPHEARSON

Marcia is a Partner in Oliver Wyman’s Health and Life Sciences Practice Group, has more than 20 years of healthcare industry experience, and leads the Health Practice’s Affordability and Quality Impact platform focused on reducing medical costs and improving healthcare outcomes. Marcia has deep expertise within the health services sector and has helped plans, providers, pharmaceutical and technology companies develop strategies to improve business performance and to assess, develop, and optimize capabilities required to achieve strategic objectives.

Relevant Experience

Led the development of OW’s Affordability and Quality Impact Platform that has partnered with 20+ clients across 50+ projects in the last 5 years delivering full transformation of Provider Network Performance, Value Based Care, Medical Cost Action Planning, Utilization, Care Management, Advocacy and Wellbeing portfolios including defining new integrated (e.g. medical/BH/Rx/SDOH) operating models, analyzing populations to determine high value target member cohorts, redesigning clinical services org and staffing structures, structuring investments and improving value delivered from new care models and provider partnerships, and aligning transformed services into market competitive base and buy up product offerings with competitive pricing and cost to deliver.

For a Fortune 50 company, defined products, business models, organizational and operating model structures, and supported go-to-market efforts for a NewCo subsidiary launching a transformed consumer-centric care model offering.

For a large health plan, led a Pharmacy Strategy initiative to determine potential impacts of changing market dynamics on the plan’s pharmacy services positioning, engaging the leadership team in organizational readiness assessment, and definition of a cohesive set of strategy pillars and initiatives for the 3-5 year roadmap.

For a multi-state health plan with captive large physician group, developed an integrated payer/physician Care Model for the Medicare and Medicaid lines of business. Conducted detailed population analysis, identified member cohorts, developed analytics, staffing models, intervention approach and implementation plan to launch an integrated care management team.

Lead multiple enterprise strategy efforts to assist Plans to define top line mission and 3-5 year strategic plans including definition of discrete initiatives across key enterprise areas including physician payment designs, brand voice/consumer experience, potential retail market entry plays, medical analytics capabilities and investments, acquisition/consolidation response considerations.

For a global health insurer, developed a health risk management strategy across 7 target countries to improve provider network, population health management, payment integrity and data analytics capabilities in order to improve medical costs performance.

For a regional health insurer, led the negotiations and contracting of value-based arrangements between the insurer and 2 of their largest provider partners (a large PCP focused IPA and the largest clinically integrated health system in the market). Conducted contract analytics, designed the arrangement structure (e.g., up/down-side risk corridors, performance benchmarks and targets, division of responsibilities, settlement methodologies), developed terms of the arrangement and successfully negotiated the contracts on behalf of the payer.