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Healthcare Systems & Services

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Payor Strategy

We help set strategies that improve quality and reduce cost in response to rising healthcare expenditures.

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The challenges facing the leaders of payor organizations—improving financial performance, increasing cost effectiveness, improving population health status, and boosting quality of care—are not new. What is different today is the increasing need to address them all.

Our strategy work focuses on driving value. The starting point varies depending on the clients and geography, but whether we are supporting a public payor, a private payor, or a mix, we have a deep understanding of the complexities our clients face and can draw upon our international experience for best practices and key insights.

Our work

We have substantial experience across the entire value chain, from health systems and payors simply to pharmacy benefits managers, policy makers, and employers. We work on redesigning care delivery and funding, and we invest in taking an informed point of view on the future of healthcare.

We help clients:

  • Redesign services around care pathways. We work with clients to review and improve performance in specific areas of care (emergency care, maternity services, and care for older people, for example). Drawing on clinical studies and extensive experience, we help clients understand what high-quality cost-effective care looks like and reallocate resources as needed. Return-on-investment analyses and cost curves help leaders identify which services to invest in and which to divest.
  • Anticipate industry evolution. We help clients understand healthcare reform, evolving consumer preferences, and demographic changes. We bring proprietary research on the attitudes of healthcare consumers and employers, proprietary modeling of the healthcare economy, and bespoke market and consumer research. With detailed modeling at the geographic and demographic micro-segment level, we help clients develop a strategy for success in a post-reform market.
  • Balance corporate portfolios. We assist clients in adjusting corporate portfolios given recent market disruptions, including evaluating potential opportunities for mergers, acquisitions, and joint ventures. We help identify where to compete, what investments to make across geographies, and where new business opportunities are—areas like administrative services organizations and government-funded managed care, for example.
  • Improve incentive systems. We advise clients on introducing innovative and effective incentive/payment systems and delivery models. These models often encourage greater integration of care with more patient involvement. We also help implement technology tools to support new care pathways and reconfigured provider networks, to monitor performance, and to support transparency.
  • Develop business unit strategy. We evaluate performance and work with clients to set strategic positioning for business areas, including individual, small group, large national, and government lines of business. For example, we draw upon a distinctive approach to understanding whether a plan is succeeding because of differentiated benefits or lower pricing.

We also work with clients across all industries to craft strategies that best meet their talent value proposition and workforce needs. We explore the implications of payor reform for systems and identify innovative opportunities they can pursue.

Proprietary tools and insights

We make significant investments in proprietary research and capability development. Some of our research on improving healthcare can be found in McKinsey’s Health International and the McKinsey Quarterly. The following includes a few of our assets and research efforts:

  • The Exchange Simulation Game allows payor executive teams to design products for a simulated exchange and observe actual consumer response. This simulation incorporates models of future Medicare growth at the county and product level.
  • Consumer Health Insight is a proprietary survey of more than 10,000 US healthcare consumers; it provides insights into how consumers make healthcare decisions.
  • Integrated care workshops can be facilitated for clients, allowing them to discuss challenges to integrated care, explore current approaches, and share success stories.
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