Perspective   Gary D. Ahlquist              Paolo F. Borromeo              Sanjay B. Saxena, MDThe Future ofHealth Insuran...
Contact InformationChicago                         San FranciscoGary D. Ahlquist                Paolo F. BorromeoSenior Pa...
EXECUTIVE        In the United States, the new healthcare reform law empha-                 sizes expanded coverage throug...
MASSIVE                                                    is recognition that Republicans in                             ...
- Is it time to make “big bets” on    Kraft Foods              Heinz            PepsiCo                                   ...
care reform was enacted in 2006,       through new health insurance            to participate in the exchange willemployer...
the employer-sponsored insurance         drop employee coverage. Yet our             and jumbo-sized companies alsomarket ...
form of higher rates. In addition,      only a tiny portion of the group        ees, because of the variance insome midsiz...
CHALLENGES TO                                           magnitude of the impact will depend                               ...
STRATEGIC      The movement to direct-to-consumer          exchanges eventually shift employer               healthcare be...
in working with employers to help            Second, health plans should partner       could more directly advise companie...
Rethinking the Traditional Health           capabilities required to deliver services   model. A company could also instit...
turbulence?    Kraft Foods              Heinz             PepsiCo                                      Kimberly-Clark     ...
CONCLUSION   Ultimately, the employer group             business of the past will serve as                                ...
About the AuthorsGary D. Ahlquist is a senior        Sanjay B. Saxena, MD, is apartner with Booz & Company         princip...
The most recent             Worldwide Officeslist of our officesand affiliates, with        Asia                Bangkok   ...
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Future of health insurance

  1. 1. Perspective Gary D. Ahlquist Paolo F. Borromeo Sanjay B. Saxena, MDThe Future ofHealth InsuranceDemise of Employer-Sponsored CoverageGreatly Exaggerated
  2. 2. Contact InformationChicago San FranciscoGary D. Ahlquist Paolo F. BorromeoSenior Partner Principal+1-312-578-4708 paolo.borromeo@booz.comAshish Kaura Sanjay B. Saxena, MDPrincipal Principal+1-312-578-4838 sanjay.saxena@booz.comNew YorkGil IrwinPartner+1-212-551-6548gil.irwin@booz.comJoyjit Saha Booz & Company
  3. 3. EXECUTIVE In the United States, the new healthcare reform law empha- sizes expanded coverage through health insurance exchanges,SUMMARY leading many analysts to project a rapid decline in the tradi- tional employer-sponsored insurance market. But a time of more ambiguous change is approaching, with new opportuni- ties as well as many challenges. Booz & Company research suggests that traditional employer-based insurance will remain a significant market that will erode more slowly and less steeply than commonly thought. Our analyses indicate that employers, though concerned about rising premiums, are unlikely to abandon employer-based health plans and force workers to find coverage on exchanges. Some small employers may do so, but the majority will continue to offer coverage for a variety of reasons ranging from a sense of moral respon- sibility to the need to attract and retain talent. As health insurers respond to the (employer group) market to a more evolving healthcare environment, retail-like market and the emergence they must tend their core employer- of relatively focused health plans with based business to secure the margins specialized capabilities that target and cash flow needed to develop and customer segments more coherently. enhance new capabilities that will In the future, companies will evolve help them adapt. They must also toward one of four primary business take a proactive role in working with models, including low-cost standard employers and brokers to innovate plans and highly diversified compa- and provide value that will sustain the nies. Depending on the customer, group market. insurers may adopt any one of a range of approaches and capabilities. Historically, health plans have Ultimately, employer-sponsored plans maintained a broad presence across will serve as the foundation for insur- customer segments. Going forward ers’ future growth no matter how we anticipate a shift from a wholesale healthcare reform shakes out.Booz & Company 1
  4. 4. MASSIVE is recognition that Republicans in Congress and, perhaps more impor- extensive research to understand the evolving needs of employers and how UNCERTAINTY tant, in governors’ offices around the they are likely to respond to the new AHEAD FOR nation could seriously undermine, slow, or whittle away at the law. law. We interviewed more than 150 executives and managers at employ- HEALTH ers across sizes, industries, and INSURERS Nonetheless, no matter what hap- pens next, some permanent disrup- regions; association members; and policy experts. We also conducted tive changes will take place in the employer focus groups and surveys to U.S. healthcare system as a result of gather additional input from nearly the passage of the Patient Protection 300 small and large employers. In and Affordable Care Act (PPACA). particular, we conducted in-depth Heinz While the new law puts a strong studies of employers in Massachusetts PepsiCo The healthcare industry is entering emphasis on making healthcare more and Utah, two states where reform Kimberly-Clark a period of even greater uncertainty, accessible, many provisions—such as efforts, most notably around health driven by regulatory, political, and small-business tax credits, employer insurance exchanges, resemble the Nestlé economic unknowns (see Exhibit 1). “pay-or-play” penalties, and health system called for by the federal health The results of Bubble = Revenue Size of the 2010 midterm elec- insurance exchanges—are spurring reform legislation. Finally, we inte- tions have made it much more diffi- significant debate over the viability of grated these inputs into a proprietary 60 cult to discern the pace and extent of 80 100 the private health insurance industry, model incorporating health planoherencefuture healthcare reform. The legisla- Score particularly the employer-sponsored premium data and estimates of likely tion is not likely to be undone, given (or group) insurance market segment. consumer and employer decision- Democrats’ veto-proof hold on the making behavior, to evaluate the eco- Senate and the public popularity of In late 2010 and early 2011, nomic impact of various scenarios. most reform elements. However, there Booz & Company conducted Exhibit 1 Drivers of Post-Reform Uncertainty - 2010 elections: What will be the impact of a divided Congress? - How much will political polarization impede implementation? - 2012 election: Will President Obama be reelected? If not, what happens to reform? Political Uncertainty - How will federal and state - Will there be unprecedented shifts regulators interpret the newly in healthcare industry profit pools? passed legislation? - Will there be a potentially massive - Will there be state (and federal?) impact on health plan business Legislative/ Economic MASSIVE rate caps on insurers (as in model and profits? Regulatory Uncertainty UNCERTAINTY Massachusetts and Maine)? Uncertainty - Is it time to make “big bets” on - To what extent can stakeholders repositioning? influence this? - Is it time to save capital and - Can health plans reposition their financial strength to navigate image, given criticism by turbulence? legislators/regulators? Stakeholder Response Uncertainty - How will key organizations in each stakeholder group respond to reform? - How will industry dynamics change across stakeholder groups? - Will there be shifts in roles in the healthcare value chain (e.g., who manages risk)? Source: Booz & Company 2 Booz & Company
  5. 5. - Is it time to make “big bets” on Kraft Foods Heinz PepsiCo repositioning? Kimberly-Clark - Is it time to save capital and financial strength to navigate ConAgra turbulence? Foods Nestlé Unilever Size of Bubble = Revenue Sara Lee A SIZABLE Unlike many prognostications fore- casting rapid decline in the employer- enrolled through company health org - How will key benefit programs. By 2016, when - How will industry0 20 40 60 EMPLOYER 80 100 sponsored insurance market, our most of the major reform Will there be shif - provisions GROUP MARKET research suggests that employer groups will remain a significant cus- are scheduled to be implemented, employer-sponsored insurance POST-REFORM tomer segment for health insurance will still constitute more than 50 plans. Today, employer-sponsored percent of the market, with 152 insurance makes up 62 percent million members enrolled in group of the insured market, with 158 plans (see Exhibit 2). Indeed, even million employees and dependents in Massachusetts, where health- National Membership Mix Shift with Reform Exhibit 2 Projected Membership Shifts, 2009-2016 NATIONAL MEMBERSHIP MIX SHIFT WITH REFORM (IN MILLIONS OF INDIVIDUALS) 2009 CAGR: ’09-’16 2016 20 -10% Uninsured 40 61 6% Medicaid 41 Medicare 2% 42 37 4 Other Public 3 Individual 16 8% 27 Small Group 33 -4% 25 (<50 employees) Midsized/Large Group 56 0% 56 (50-1,000 employees) Jumbo Group 69 1% 71 (1,000+ employees) 2009 2016 w/Reform Notes: Does not include illegal immigrants. Uninsured estimates from CBO, and employer estimates from Booz & Company intellectual capital. Aggregation may not sum to total U.S. population. Source: Kaiser Employer Health Benefits 2009; Census 2007; Congressional Budget Office; Booz & Company analysis Booz & Company 3
  6. 6. care reform was enacted in 2006, through new health insurance to participate in the exchange willemployer group coverage programs exchanges, and the remainder will switch from the group market. Somecontinue to make up 64 percent of enroll in existing employer group observers expect that the introduc-the health insurance market, down plans. tion of exchanges and significant fed-only three percentage points since eral subsidies for individuals (earningreform went into effect. The eventual size and long-term as much as 400 percent of the federal viability of the employer group poverty level) will lead a significantMore generally, healthcare reform market will be determined chiefly by number of businesses to “dump”will unquestionably lead to a larger the success of new state and regional employees by dropping coverage oroverall market for health insurance. health exchanges. These will inevi- to “switch” them into employer-paidBased on our scenario modeling, tably attract not only the uninsured, exchange plans.nearly 25 million uninsured people but also some people currently cov-will obtain coverage after 2016. The ered by employer-sponsored insur- Our research findings and simula-majority, nearly 60 percent, will ance. There are open questions, such tion analysis reveal that only a smallenter a vastly expanded Medicaid as whether smaller employers (those portion of employers will do so. Asprogram, about 28 percent will with fewer than 50 workers initially, a result, we project that 5 millionget individual insurance primarily 100 eventually) that are eligible to 7 million individuals will exit The eventual size and long-term viability of the employer group market will be determined chiefly by the success of new health exchanges.4 Booz & Company
  7. 7. the employer-sponsored insurance drop employee coverage. Yet our and jumbo-sized companies alsomarket by 2016. An estimated 3 feedback from extensive interviews report a moral obligation to retainmillion to 4 million will be dumped with benefit managers, chief human employee health insurance coverage.because firms decide to stop offering resource officers (CHROs), and chiefcoverage, and 2 million to 3 mil- financial officers (CFOs) indicates Midsized Employers May Shiftlion small-group employees will be that larger employers will adopt a to Self-Insuranceswitched. The overall propensity for long-term “wait and see” approach Midsized companies are also unlikelyemployers to change coverage will be that is unlikely to result in significant to drop their current employeelow, and the velocity of change will dumping or switching. Similarly, the healthcare coverage, for many ofbe rather slow. For the most part, vast majority of large employers in the same reasons as their largeremployers’ response to reform will be our Massachusetts employer survey counterparts. There is significantguided by cost and other factors such plan to continue providing health interest among these employers inas the potential risk to their reputa- insurance. Moreover, our economic moving from fully insured to self-tion and their ability to attract and modeling suggests that employers funded products (where the employerretain talent. that consider dropping coverage and assumes direct risk for paying paying the associated penalty will healthcare claims), as most large andLarge and Jumbo Employers Unlikely need a significant cost–value differ- jumbo employers have progressivelyto Drop Current Coverage ential to offset the risks to employee done over the past decade. TheRecent press coverage has high- morale and retention. Although some anticipated shift is primarily drivenlighted concerns about healthcare employers might save money by drop- by the desire to avoid costly reforminsurance raised by certain major ping coverage and paying penalties, provisions that introduce healthemployers, including AT&T, Verizon, many report that the savings may insurer premium taxes and medicalCaterpillar, and McDonald’s: not be worth the potential downside. loss ratio constraints on fully insurednamely, that new regulations and Many large employers, particularly products, both of which insurers areadded costs would lead them to those with more than 500 workers, likely to pass on to employers in theBooz & Company 5
  8. 8. form of higher rates. In addition, only a tiny portion of the group ees, because of the variance insome midsized employer focus group market—are the most likely to wages, the number of subsidy-eligibleparticipants say self-insuring offers drop coverage altogether, leaving employees, and employee expecta-greater flexibility and creativity in their employees to obtain insurance tions of healthcare benefits as a con-areas such as benefit design, health through exchanges. Focus groups dition of employment. In principle,and wellness incentives, and care suggest that—if exchanges offer a they may explore exchange productsmanagement programs. Again, viable alternative—those microbusi- in hopes of reducing costs, but mostwhile most midsized employers seem nesses with relatively low average of them feel obliged to continue pro-inclined to continue offering health wages and a high proportion of viding coverage for their employeesinsurance, some companies, such as employees eligible for individual after 2014. Even among companiesa local 250-worker factory, a private subsidies will be the most tempted this size, massive exchange switch-equity–owned firm, and a financially to drop coverage and direct employ- ing will not happen overnight. Focusdistressed business, are considering ees to purchase through exchanges. groups reveal that microgroups willdropping coverage altogether. Indeed, membership in existing pri- closely evaluate the option to switch, vate small-business exchanges indi- and even for today’s private small-Smaller Firms Most Likely to cates that a large majority come from business exchanges, adoption hasDrop Coverage groups of fewer than 10 employees. been slow.Microbusinesses—those with fewer Larger and well-established firmsthan 10 employees, which represent have less incentive to dump employ- Microbusinesses—those with fewer than 10 employees—are most likely to drop coverage, leaving their employees to obtain insurance through exchanges.6 Booz & Company
  9. 9. CHALLENGES TO magnitude of the impact will depend on a given insurer’s book of busi- Congressional Budget Office (CBO) estimates of the future size of thePROFITABILITY ness (see Exhibit 3). For instance, post-reform insured market are overly insurers with more business in the optimistic, potentially overstating the jumbo and government segments will 2016 insured market by as many as 7 see more stability. Conversely, those million individuals. A weak individual catering primarily to the individual mandate (or no individual mandate, and small-group markets will face if the Virginia court ruling is upheld significant uncertainty as exchanges by the U.S. Supreme Court) will yieldAlthough the employer-sponsored are introduced. even lower enrollment levels. Finally,group business is unlikely to erode federal reform legislation has intro-as rapidly as widely predicted, health While reform provisions will result duced significant constraints, such asreform will unequivocally diminish the in sizable membership growth in the minimum actuarial value thresholds,financial viability of the health insur- Medicaid and individual markets, underwriting restrictions, and medicalance industry. Indeed, every segment margins will be considerably lower loss ratio requirements, limiting howwill experience declining profitability than in the employer group busi- insurers can operate and profit frombetween now and 2016, though the ness. Our analysis also indicates that their core health insurance business. Will there be shifExhibit 3Healthcare’s Bleak Outlook EXPECTED MEMBERSHIP GROWTH AND CHANGE IN MARGIN (2009-2016 PROJECTIONS, IN MILLIONS OF INDIVIDUALS) 10 8 6 Medicaid (61M) Medicare (42M) Government 4 Expected Jumbo Group (71M) Individual/Small Group Membership 2 Growth Midsized/Large/Jumbo Group (% CAGR, 0 2009-2016) NOT SHOWN: -2 Small Group Non-Exchange (22M) Midsized/Large Group (56M) Projected On-Exchange Individual/Small Group -4 Market (19M-22M) -6 Individual Non-Exchange (10M) -8 -3.5 -3.0 -2.5 -2.0 -1.5 -1.0 -0.5 0 0.5 1.0 1.5 Expected Change in Margin (%, 2009-2016)Source: Membership projections based on Booz & Company analysis; margin projections based on Goldman Sachs’ 10-Year Industry Model for Managed Careand Booz & Company analysisBooz & Company 7
  10. 10. STRATEGIC The movement to direct-to-consumer exchanges eventually shift employer healthcare benefits may be slow, but group membership into a moreIMPLICATIONS it will also be persistent. Every insurer retail-like environment, health plansFOR HEALTH will need to establish a new strategy will experience a steady erosion of and capabilities system to accommo- their fully insured group business.INSURERS date this shift. This will mean getting Uptake in the exchanges will likely be used to a more retail environment, in gradual and vary by state, beginning which exchanges increasingly allow with microgroup segments. As such, consumers to “shop” for healthcare it is imperative for health plans to plans in the same way that they cur- carefully manage their group business rently shop for life insurance or other to ensure that it generates sufficient financial services. margins and free cash flow to enable reinvestment in the new capabilities Managing the Core Employer that will be necessary to compete in Group Business the post-reform era. Overall, our research suggests that health insurers have a longer runway As part of this transition from a to derive benefits from their tra- wholesale (employer group) to retail ditional employer group business market, health plans need to pursue than some analysts have projected. a number of strategies. First, they Nonetheless, as health insurance should take a more proactive role Health insurers have a longer runway to derive benefits from their traditional employer group business than some analysts have projected.8 Booz & Company
  11. 11. in working with employers to help Second, health plans should partner could more directly advise companies,sustain the viability of the group more closely with their key brokers a role traditionally held by benefitmarket. Our research shows that most to jointly manage and support the consulting firms.employers are aggressively looking for group business. While brokers canalternative ways to manage costs, but expect volatility in the microbusiness Third, given the likely shift to self-have not seen health plans as partners segment, larger companies are likely funded arrangements, particularlyin these efforts. It is up to the insurers to maintain their long-standing among midsized employers,to give them reason to do so. relationships with brokers, whom health plans should introduce they perceive as trusted advisors. more administrative-services-Moving forward, the most success- Our research also suggests that, only (ASO) packages to serve thisful insurers will be those that help given the complexity and importance segment. Today’s ASO products areemployers manage costs to increase of the health insurance purchasing characterized by a high degree ofaffordability and enhance employee decision, health insurance brokers complexity and customization forproductivity. For instance, through will continue to provide a service large and jumbo employers. In themore innovative payor–provider to companies by helping them sort future, as ASO moves downmarket,collaboration and care management through the complexity to find value. greater standardization will beprograms, leading plans are already In this role, they will be more akin to required to profitably serve the newengaging with employers to jointly real estate agents, who have retained groups. Finally, while the shift fromaddress costs. Others are design- a place in their industry, than to risk-based revenues (in fully insureding benefits for employers based on travel agents, who have been largely products) to fee-based revenues (ina limited network of providers tied disintermediated by online solutions. ASO products) will have significantto local accountable care organiza- Health insurers should redefine their financial implications, insurers shouldtions (ACOs) with bonuses aligned to broker engagement strategy from develop complementary add-onencourage member engagement. Plans today’s transaction-based model to offerings (e.g., specialty products,will also need to work with employ- a strategic partnership model. For health and wellness, work-lifeers to co-design low-cost alternative example, top-performing brokers, services) to enhance their shareproducts that still adhere to standards armed with the proper incentives, of wallet.laid out in the reform regulations. tools, and other support mechanisms,Booz & Company 9
  12. 12. Rethinking the Traditional Health capabilities required to deliver services model. A company could also instituteInsurance Business Model to that market, and the full lineup of a hybrid of these various approaches,Post-reform, health plans will need to products and services. This will rep- as long as the same system of a fewconsider a number of important ques- resent a change for many companies. key capabilities were used to servetions with respect to their key capa- Historically, health plans and other all of its customers. If insurers take abilities and future business models, insurance companies have maintained more diversified path, they will needincluding the following: a presence across as many customer to reconcile the cost and culture issues segments as possible, marshaling sepa- that may arise in attempting to pursue• What is the future role of the rate products and capabilities for each a hybrid model. For example, can the health plan? Will it continue to if necessary. Going forward, they may new low-cost products needed to suc- focus on administering health ben- feel compelled to serve fewer segments ceed in exchanges be supported on the efits, or will it play a larger role in in a more coherent way, by focusing same higher-cost, flexible operating enhancing medical value? on just one primary business model— chassis plans used for large or jumbo or “way to play”—that applies to all accounts?• What business models and capa- of their chosen customers. This will bilities will be required to serve allow them to gain efficiencies and Low-cost standard plans will dif- different target segments coherently invest more effectively by applying the ferentiate themselves based on retail in the future? same system of capabilities to all their marketing, network management, products and services. and price. Their capabilities will• Given the need for critical new be retail excellence, low total cost, capabilities, what steps can health There will be several viable business and regulatory relationship manage- plans take to streamline costs in models to choose from (see Exhibit 4). ment required in the predominantly less critical functions and secure Some of them will be relatively “pure government-sponsored (Medicare funding for new investments? tone” strategies: being a low-cost and Medicaid) and exchange-based standard plan, a higher-cost custom segments. In contrast, higher-costLooking ahead, we see the emer- plan, a medical value healthcare custom plans, aimed at midsized andgence of health plans with special- plan, or a broader-service company, large group segments, will differenti-ized capabilities to target segments expanding beyond health insurance in ate themselves on product design,coherently—in other words, with a some coherent way. In each case, the analytics, and complex administra-high degree of alignment between company would serve only the cus- tive capabilities. The third pure-tonea company’s market strategy, the tomers that would benefit from that approach, aimed at providing better10 Booz & Company
  13. 13. turbulence? Kraft Foods Heinz PepsiCo Kimberly-Clark ConAgra - How will key organ Foods - How will industry d Unilever - Will there be shifts medical Size of Bubbleinnovate on prod- value, will = Revenue of products and services—possibly base. It may also explore business-to- Sara Lee uct, member behavior, and provider including some that have tradition- business opportunities to monetize0 20 40 60 levers 80 achieve superior outcomes, to 100 ally been outside the health insurance its capabilities by marketing them to lower costs, and improved employee domain, such as other insurance prod- other companies, including its health productivity. Finally, the broader- ucts or even the delivery of care—to plan competitors. service company will follow a retail- capture a greater share of spending like approach to offering a range from its core health plan customer Exhibit 4 Future Health Plan Business Models Customer Segments Business Model Medicare Medicaid Exchanges Midsized Group Large Group 1. Low-Cost Key Capabilities Standard Plan - Consumer segmentation and marketing - Low-cost standardized/modularized health benefits and loyalty programs - Exchange-based distribution - Lower-cost, high-performance provider networks - Extremely lean administrative infrastructure 2. Higher-Cost Key Capabilities Custom Plan - B2B and B2B2C segmentation - Flexible/customized benefits - Broader provider networks - Advanced administrative capabilities/tools - High level of support 3. Medical Value Key Capabilities Healthcare Plan - Ability to manage utilization by “high risk” populations Could serve a broader market - Value-based benefit designs including midsized and large groups - Dramatically reduced medical cost through transformed if risk-adjusted reimbursement for provider relationship managing higher-risk populations - Integration of care across local community services (e.g., psycho/social) takes hold - Diversified portfolio of health solutions effectively targeting healthy, at-risk, and chronically ill 4. Broader-Service Key Capabilities Company - Cross-selling of ancillary health products to existing customers - Greater expansion outside health to offset the risk in the core health business Source: Booz & Company Booz & Company 11
  14. 14. CONCLUSION Ultimately, the employer group business of the past will serve as Employers will maintain a huge stake in healthcare and will be the foundation for growth in the valuable partners with health future, as insurers devise strategies insurers in addressing the critical to compete in new markets. Insurers issue of medical costs. From what will need to renew efforts to capture we see in the early exchanges, costs as much value as possible from the and premiums remain difficult to current core business. They should manage. To initiate change, insurers focus on managing employer costs need to work with employers— and healthcare affordability, and along with providers, government, differentiating on medical value, as and consumers—to develop new they search for diversification and structures and capabilities that will opportunities to expand market create medical value. Without new share. Savings from these efforts and innovative approaches to this will provide capital for investment central problem, the promise of in new capabilities supporting new reform will remain only a promise. business models.12 Booz & Company
  15. 15. About the AuthorsGary D. Ahlquist is a senior Sanjay B. Saxena, MD, is apartner with Booz & Company principal with Booz & Companybased in Chicago. He in San Francisco and leadsspecializes in strategy and the firm’s West Coast healthorganization development for practice. He advises healthcareinsurance companies, health clients on strategy developmentplans, and health providers. and capability building, specializing in payor–providerPaolo F. Borromeo is a collaboration, next-generationprincipal in Booz & Company’s payment models, and carehealth practice based in delivery innovation.San Francisco. He is a coremember of the firm’s healthcarereform team and specializesin developing post-reformbusiness unit strategies for payor clients.Booz & Company 13
  16. 16. The most recent Worldwide Officeslist of our officesand affiliates, with Asia Bangkok Helsinki Middle East Florham Parkaddresses and Beijing Brisbane Istanbul Abu Dhabi Houstontelephone numbers, Delhi Canberra London Beirut Los Angelescan be found on Hong Kong Jakarta Madrid Cairo Mexico Cityour website, Mumbai Kuala Lumpur Milan Doha New York Seoul Melbourne Moscow Dubai Parsippany Shanghai Sydney Munich Riyadh San Francisco Taipei Oslo Tokyo Europe Paris North America South America Amsterdam Rome Atlanta Buenos Aires Australia, Berlin Stockholm Chicago Rio de Janeiro New Zealand & Copenhagen Stuttgart Cleveland Santiago Southeast Asia Dublin Vienna Dallas São Paulo Adelaide Düsseldorf Warsaw DC Auckland Frankfurt Zurich DetroitBooz & Company is a leading global managementconsulting firm, helping the world’s top businesses,governments, and organizations. Our founder,Edwin Booz, defined the profession when he estab-lished the first management consulting firm in 1914.Today, with more than 3,300 people in 61 officesaround the world, we bring foresight and knowledge,deep functional expertise, and a practical approachto building capabilities and delivering real impact.We work closely with our clients to create and deliveressential advantage. The independent White Spacereport ranked Booz & Company #1 among consult-ing firms for “the best thought leadership” in 2010.For our management magazine strategy+business,visit to learn more aboutBooz & Company.©2011 Booz & Company Inc.