Insights on Healthcare Systems & Services


Health system financing: Tips for emerging markets

– Many countries with emerging economies are considering health system financing transformation. Five no-regrets tips can help them build a strong foundation for their future health system.


McKinsey on Healthcare

Our latest insights into the world's largest industry.

Center for US Health System Reform

Our source on the economics of health, implications of the Affordable Care Act and other health policies related to reform, the Center undertakes original research and develops tools to help navigate in a post-reform era.

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Artificial intelligence in health insurance: Smart claims management with self-learning software

– At health insurers, artificial intelligence can strengthen claims management by systematically identifying and correcting errors... while avoiding ineffective interventions.

The Sanitas journey: A digital business model at its core

– In this interview, Otto Bitterli (Chairman of Sanitas Health Insurance) discusses the company’s digital transformation and its... commitment to being an innovative long-term partner to its customers.

Delivering bold performance in an ever-changing healthcare landscape

– The odds are stacked against healthcare organizations as they pursue sustained growth and differentiated performance. Six strategies... can help them achieve successful transformations at scale.

2016 individual market losses are in the high single digits—a slight improvement from 2015

– A new McKinsey analysis suggests that overall carrier losses in the individual market were probably smaller in 2016 than in 2015... (7% to 9% of premiums, versus 10.1% of premiums).

Against the odds: How payors can succeed under persistent uncertainty

– The US health insurance industry continues to be defined by uncertainty. The 25 articles in this compendium can help health insurers... navigate the changes ahead.

Distributed sites of care: At the tipping point?

– Increasingly, consumers are seeking services at sites of care outside of the traditional health system infrastructure. This shift... has important implications for how health systems think about their asset base and scale.

Enabling healthcare consumerism

– Companies that can learn to understand, guide, and engage healthcare consumers, while inspiring their loyalty, have a significant... opportunity to change the healthcare landscape.

Growing employer interest in innovative ways to control healthcare costs

– Employers are showing increasing interest in new payment, delivery, and funding models. To capture the opportunity, payors must... be able to target appropriate employers; educate employers, employees, and brokers; and demonstrate savings.

Hospital networks: Perspective from four years of the individual market exchanges

– An analysis of the individual market health plans being offered across the U.S. reveals that the trends toward narrowed hospital... networks and managed care continue.

Looking ahead in Medicaid: Options for states and the implications for payors and providers

– This paper explores opportunities states could consider to improve their Medicaid programs, both to control spending and improve... the program’s performance.

US health insurers: An endangered species?

– Converging trends are disrupting the US healthcare industry. Health insurers are not likely to disappear, however, despite predictions... to the contrary. Insurers that can take advantage of these trends are likely to find that their best years are ahead.

Value-based care: Is it sustainable?

– Four fundamental questions can help payors and providers improve productivity and better control utilization—the prerequisites... for making value-based care sustainable.

Where to compete in today’s healthcare market

– To select which markets to focus on—both within health insurance and in adjacent businesses—payors must have strong market insights,... the fortitude to make tough decisions, and the agility to alter course rapidly.

Why agility is imperative for healthcare organizations

– A new concept, organizational agility, can help healthcare companies adapt more quickly to changing customer needs, competitor... responses, and regulatory guidelines—without requiring a full-scale restructuring.

Why understanding medical risk is key to US health reform

– In our healthcare system, those in the best position to control risks and costs often have inadequate incentive to do so. Refining... healthcare financing and reimbursement requires a deep understanding of the nature of medical risk.

What can states do to change key parameters of Medicaid?

– In part I of this February 2017 conversation, Erica Coe and Stephanie Carlton of the McKinsey Center for US Health System Reform... discuss this question with Thomas Barker, former General Counsel at the Department of Health and Human Services and the Centers for Medicare & Medicaid Services, and Ken Choe, a former Deputy General Counsel and Counselor to the Office of Health Reform at HHS. Mr. Barker is now a partner and co-chair of the Healthcare Practice at Foley Hoag. Mr. Choe is now a partner at Hogan Lovells.

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