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Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Acce...
Learn how to make a
competitive comeback.
Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Pe...
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Bigger Isn’t Always Better: Regional Health Plans’ Competitive Advantage

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Bigger isn’t always better, even though the nation’s top eight health plans own 50 percent of the market. Smaller, regional plans are at a disadvantage when it comes to the ability to invest in digital capabilities, shift to value-based care and reduce their cost to serve. However, there are several opportunities for smaller plans to turn perceived disadvantages into market-differentiating advantages that improve competitiveness.

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Bigger Isn’t Always Better: Regional Health Plans’ Competitive Advantage

  1. 1. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. Strategy | Consulting | Digital | Technology | Operations
  2. 2. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. HEALTH PLAN PROVIDERS: THE PRESSURE FOR PERFORMANCE Health plan providers of all sizes face pressure for lower pricing, better customer service and innovative product lines. National plan providers consistently outperform regionals. The nation’s top eight health plan providers (representing ~2% of the total) own 50% of the market. Amid these challenges, there are several opportunities for smaller regional plan providers to turn disadvantages into market-differentiating advantages. By duplicating value-add capabilities from nationals, “born digital” and other high-performing regional plans, smaller regional plan providers can improve their competitive agility.
  3. 3. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. GREATER LOCAL IMPACT WITH TARGETED INVESTMENTS Bigger plan providers have made bigger bets, investing in digital, new revenue ventures and acquisitions. Regionals can focus their attention and stretch investment dollars by making small, more strategic moves that cater to local markets through: • Building close relationships with local providers • Making customer service improvements • Driving innovations that address local consumer needs
  4. 4. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. ACTIVATING VALUE-BASED CARE BY OPERATING AS CARE COORDINATION PLATFORMS Providers are moving from a fee-for-service model to a value-based care model where success hinges on quality and outcomes. Care coordination has become more important than ever across providers, plans and patients. Regionals tend to be the largest payers in their home markets. This advantage can be used to build partnerships with local providers to become the preferred enablers of value-based care in the communities they serve.
  5. 5. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. PARTNERING DIFFERENTLY HELPS REGIONALS WORK MORE EFFICIENTLY The national plans have tried to build on their scale advantage through merger activity. Smaller plans can’t spend millions on a new acquisition, but they can pivot toward innovations by partnering quickly to adopt new capabilities. Post-merger, large health systems are losing out on $4-$19 million in annual cost savings per hospital and losing revenue uplift of $2.5-$6 million per hospital per year due to not capturing synergies.
  6. 6. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. SO HOW CAN SMALLER HEALTH PLAN PROVIDERS WIN BIG?
  7. 7. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. BY FOCUSING ON THE RIGHT THINGS Maximize connections with local customers, partners and providers. Smaller plan providers know local communities, organizations and providers on a deeper level than nationals, so they understand the capabilities needed most—and where they can fill the gaps.
  8. 8. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. BY GOING ABOUT IT THE RIGHT WAY Redesign the operating model to create shared outcomes with providers and drive internal administrative efficiencies. Pivoting the operating model toward a relationship/partnership model gives smaller plan providers better opportunities for: • Collaboration with providers • Transparency • Shared strategic vision
  9. 9. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. BY ENABLING THE RIGHT PEOPLE Gain virtual scale and reduce costs by appropriately shifting work to the right people. Smaller plan providers can scale smarter by using digital technology and strategic partners. For example: • Using digital channels and technology to enable customer and broker self-service. • Shifting more of the cost base from fixed to variable. • Reducing costs by improving self-service options and moving work to lower cost on shore or offshore locations.
  10. 10. Learn how to make a competitive comeback. Copyright © 2017 Accenture All rights reserved. Accenture, its logo, and High Performance Delivered are trademarks of Accenture. Follow us on Twitter: Follow us on LinkedIn: BIGGER ISN’T ALWAYS BETTER https://www.accenture.com/regionalcompetitiveadvantage @AccentureStrat https://www.linkedin.com/company/ accenture-strategy@AccentureHealth

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