Payer/Provider/Services

Insurance companies, healthcare providers and other service providers are competing on a radically altered playing field due to healthcare reform in the US. Bain works alongside clients not only to develop the right strategy, but also to implement it quickly and efficiently.

What we do

Providers must demonstrate continuous improvements in patient outcomes while taking on more responsibility to contain costs. Private payers need to reevaluate how to serve customer segments and employ new pricing and service models. Service and software providers must act as the levers by which the system delivers better clinical outcomes at a lower cost.

Many of the current initiatives payers and providers are implementing are not new, but there is a greater sense of urgency. Bain's work with leading payers, providers and other healthcare service companies addresses many of the key issues industry players face: cost reduction and efficiency, IT strategy and assessments of new IT investments, growth strategy, customer loyalty and the drivers of customer satisfaction, and adjacent business growth. By drawing on our cross-sector industry expertise and insights, we can help healthcare companies win in a more demanding environment.

Our perspective

The industry's profit pools are under pressure as policy—medical loss ratio mandates, exchanges, new pricing guidelines and a potential substantial increase of Medicaid patients--becomes practice. With policy changes coming swiftly, legislation will continue to evolve. Some imperative areas of focus will be:

  • Reducing costs and increasing efficiency: In a world where pricing is more regulated, lowest cost wins. Payers and providers can find ways to manage rising medical costs by using technology and business intelligence. Controlling medical costs will require new incentive systems that encourage the right behaviors among patients/members and clinicians.
  • Improving customer loyalty to drive local scale: As has been the case for decades, healthcare companies can increase the efficiency of their assets—as well as improve the probability of being a price-setter rather than a price-follower—by building their share in the local markets. Customer loyalty will be a higher priority in the future.
  • Expanding beyond the core: Margins may be permanently constrained for payers and providers in the US. Adjacent markets such as new services, geographies and business models may offer better growth opportunities than the core.