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Center for US Health System Reform

Undertake original research to help clients understand and navigate a complex, ever-evolving regulatory landscape

Drawing on our real-world industry expertise, proprietary research, and economic analysis, we help inform opportunities for value creation that emerge from changes in the regulatory environment. We also support institutions craft their strategies and business plans to effectively respond and adapt to changes based on policy and regulatory evolution.

We monitor and analyze regulatory and policy changes at the state and federal levels, including their impact on the following areas:

  • competitive dynamics across all insurance markets
  • innovative payment models (for example, for Medicare accountable care organizations and direct contracting)
  • developments in digital and healthcare consumerism
  • strategy and investment consideration

What we do

Access to unparalleled expertise and insights

We build proprietary tools and assets, such as the individual-exchange-product database, national consumer surveys, and the Medicare Advantage product and supplemental-benefits database to help clients make well-informed, strategic decisions.

Leading perspectives

We advance knowledge through distinctive research on the business implications of public policy shared through publications, presentations, and client discussions (for example, more than 300 media citations and more than 100 conferences and speaking engagements since 2017).

Featured capabilities

We collaborate closely with colleagues from across the healthcare sector to track and model the impact of regulatory change on market and consumer dynamics. Our research and thinking, led by McKinsey experts with deep business and policy backgrounds, draws on a network of leading healthcare economists, lawyers, former federal and state leaders, and market experts.

Real-time tracking of state and federal policy activity

We rapidly analyze active and proposed policy changes—such as state waivers, pricing legislation, transparency rules, and structural reform—to understand the key implications for healthcare stakeholders across the value chain and work with clients to proactively address strategic opportunities and risks.

Medicare Advantage landscape analytics

We use advanced analytics to evaluate the Medicare Advantage market landscape at the county level and leverage proprietary tools to assess product and pricing dynamics (for example, Medicare Advantage supplemental benefit assessment tool, Medicare Advantage quality and performance tool, and risk-coding model).

Individual market database and insights

Our comprehensive database integrates federal and state data to enable a granular view of the individual exchange market and landscape including pricing, enrollment, and consumer preference trends.

Proprietary tools and resources

We collaborate across McKinsey to develop cross-cutting tools including our payer financial database across commercial and public lines of business; episode-based and total cost of care payment models; next-generation provider network and care-management analytics; and consumer, employer, and healthcare broker surveys.

Examples of our work

Identify and prioritize investment opportunities

We support investors—including strategic buyers and private equity—to understand opportunities emerging from the latest legislative and regulatory reform trends, identify attractive investment areas and assets across the healthcare value chain, and develop a clear growth agenda to succeed in the future policy environment.

Strengthen operational readiness

We worked with a regional, rural, not-for-profit provider system to develop a six-part strategic plan to address management concerns about the future in the context of new reforms. Our work delivered up to a 10 percent impact on operating performance, or a cumulative operating-income impact of up to $1 billion over nine years.

Improve product performance

A Medicare Advantage plan sought to increase its enrollment levels. Based on a nuanced understanding of Centers for Medicare and Medicaid Services regulations, we helped the plan develop a provider-led marketing channel that used provider partners to stimulate dialogue with Medicare fee-for-service patients about the benefits of Medicare Advantage. These efforts doubled the target growth rates for the fall enrollment period.

Expand market presence

A regional not-for-profit plan with a large presence in the individual market wanted to capitalize on the opportunity provided by the introduction of individual market exchanges. We helped the plan achieve a successful open-enrollment season and transition its targeted business segments from pre–Patient Protection and Affordable Care Act (ACA) to after-ACA products—sales exceeded expectations, and profit margins met expectations.

Redesign compliance capabilities

Supported an integrated delivery and finance system in transforming its compliance capability to ensure both provider and payer functions were able to efficiently manage risks. Identified best practices from across industries on designing organization structure to allow for effective decision making and promoting a compliant culture.

Featured insights

Executive Briefing

Administrative simplification: How to save a quarter-trillion dollars in US healthcare
– About thirty known interventions could deliver up to $265 billion in annual savings for US healthcare.
Article

The math of ACOs
– Several factors will shape the financial performance of physician- and hospital-led organizations under total cost of care payment... models.
Article

The exciting news in Medicare is happening at the kitchen table—not on the debate stage
– With so much attention focused on the debate over the merits of Medicare for All, it is easy to lose sight of changes in Medicare... Advantage.
Article

Insights from McKinsey's Consumer Social Determinants of Health Survey
– Survey findings shed light on how social determinants of health affect healthcare utilization rates and consumers interest in... social program offerings.

Featured experts

Stephanie Carlton
Partner, Dallas
Advises public- and private-sector leaders on strategy and growth decisions by leveraging her expertise across the clinical, business,...
David G. Knott
Senior Partner, New York
Leads the firm’s Center for US Health System Reform and Medicaid work, drawing on 30 years of experience with national and regional...

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