Healthcare Payers & Delivery Systems

Our perspective

Healthcare payers and delivery systems are facing disruptive changes. Cost pressure and healthcare reform has opened the doorway to new ways of doing business. Private payers need to reevaluate how to design products that are still relevant in a rapidly changing environment, build solid relationships with their members, and support providers with care management tools and reimbursement systems that encourage higher quality of care at lower cost. Delivery systems must prepare to take on more responsibility to contain costs while demonstrating continuous improvements in patient outcomes.

Many of the current initiatives healthcare payers and delivery systems are implementing are not new, but there is a greater sense of urgency. They will need to embrace the disruptive changes that are altering the competitive landscape and find new opportunities in both existing and new markets.

What we do

Bain's work with leading healthcare payers and delivery systems addresses key issues faced by industry players and draws on our cross-sector industry expertise and insights. We work with payers and delivery systems to help them focus on the following areas imperative to their success:

  • Mergers & Acquisitions. Bain helps healthcare companies significantly improve their odds of successful M&A through an integrated, battle-tested approach that links acquisition strategy, due diligence and merger integration. Bain works closely with our clients to make their M&A transactions pay off by developing a clearly articulated strategy, integrating where it matters and acting quickly to create value for shareholders.
  • Bending the medical cost curve. Controlling medical costs will require achieving true integrated care, introducing population health management systems and reducing utilization by aligning incentives to encourage the right behaviors among patients/members and clinicians.
  • Designing the organization for integrated care delivery. Healthcare delivery systems must adapt their decision-making processes to integrate care across disparate sites and providers. These companies must identify the highest-value decision opportunities and build enduring behaviors, measures and incentives throughout the organization to deliver better outcomes at lower cost.
  • Improving customer loyalty. Unsustainable cost growth and increasing consumer engagement are changing the behavior of purchasing decision makers—and decision criteria—throughout the healthcare industry. To find opportunities amid these dramatic shifts in the customer environment, leading healthcare payers and delivery systems are learning new ways to identify their true customers, understand those customers' needs and adapt their offerings to create powerful advocates.
  • Focusing on local scale. As has been the case for decades, healthcare payers and delivery systems 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.
  • Optimizing the portfolio. Both healthcare payers and delivery systems must take a hard look at their assets and investment opportunities in order to achieve full potential of their current and future portfolios. They will also need to make hard choices between efficiency vs. effectiveness and short-term vs. long-term returns.
  • Improving care delivery with healthcare IT. Deploying healthcare information technology strategies, including mobile apps, patient portals or other digital health tools, can also help manage rising medical costs, while improving care delivery, care management and operational transparency.
  • Expanding beyond the core. Margins may be permanently constrained for payers and delivery systems in the US. Adjacent markets, such as new healthcare services, geographies and business models, may offer attractive growth opportunities.
Insights
We develop insights that work for our clients. Our approach and recommendations are highly customized and lead to practical actions. Below is a selection of our experts' perspectives on important issues—for our clients and their industries. View a comprehensive list of Bain's healthcare publications, or stay current on the topics you care about most by downloading the Bain Insights app today.