Identifying innovative ways to address healthcare value and affordability. Healthcare improvements have dramatically increased life expectancy, and new treatments are improving quality of life for many populations. Yet with this progress comes daunting economic challenges. For at least 40 years, healthcare spending in the United States has outpaced GDP growth. We work with private and public healthcare leaders to identify innovative ways to tackle the biggest healthcare challenges and improve the productivity and quality of healthcare delivery.

Advanced Analytics

Enabling healthcare organizations to harness the power of advanced analytics and artificial intelligence. We use a proven set of tools and expertise to transform healthcare companies into analytics-enabled organizations as well as help drive real tangible value against proven use cases. Whether the goal is improving health outcome, increasing efficiency, improving health outcomes, or driving innovation and growth, artificial intelligence (AI) has the power to shape the industry meaningfully.

Payers, providers, and technology companies have access to vast and growing amounts of internal and external data. With this amount of data comes the promise of better understanding and prediction of patient, customer, and employee needs. Navigating this opportunity and converting it into tangible value for businesses and their constituents requires a new approach for collaborating across the enterprise. Analytics capabilities are core to capturing this value, as is the ability of leaders and frontline staff to know how and when to leverage analytics to improve their overall performance.

What we do

• Enterprise-analytics strategy - We help organizations build compelling, enterprise-wide analytics visions and strategies aligned with their own business aspirations. We can help create road maps for advanced-analytics use cases, make the case for change, and understand the value at stake. Our ongoing expertise and support help analytics teams improve their organizations, processes, and capabilities so they can stay on the cutting edge and develop critical insights from their own data.
• Capability diagnostic and opportunity identification - We take a comprehensive, holistic approach to assessing the capabilities across the organization to make sure all the capabilities are in place to enable analytics success.
• Specific use cases - Our team of engineers and healthcare experts design and develop analytics applications and assets for healthcare-specific use cases, including procedure-specific competitive benchmarks, doctor performance, configuration of insurance claims, and visualization of the health of large patient populations.
• Core technology and building scalable digital platforms - Integrating analytics into digital applications is creating a need for payers and providers to transform their technology, architecture, and IT operating model to achieve and sustain the required impact. We have facilitated multiple transformations to create reusable, and scalable platforms that can be leveraged in an agile model to enable analytics impact through digital.

Business Building

Achieving breakout growth by creating, launching, and scaling new businesses in healthcare. With organizations facing unprecedented rates of change in healthcare, new recipes for success will be necessary moving forward. Healthcare leaders will need to create new businesses and think beyond their core capabilities to help unlock the next big waves of growth. We work with both high-growth and established organizations to build and scale innovative new businesses from scratch that thrive. We put the customer at the heart of every business and every operating model, building the capabilities necessary to compete and grow in healthcare.

Commercial

Helping payer organizations drive sustainable growth and deliver an enhanced value proposition to customers through distinctive data- and advanced-analytics-driven insights. Payers in the individual and employer-sponsored health-insurance markets are looking for new ways to improve performance and drive growth. We help clients identify product-innovation, pricing-excellence, sales-force- effectiveness, and ancillary growth levers that can drive sustainable growth, ensuring payers bring improved experience, outcomes, and savings to employers and members. Over the past two years, we have served a breadth of national and regional carriers, delivering more than $2 billion in earnings growth through our unique data, advanced analytics, and deep expertise-based approaches.

What we do

• Pricing sophistication - We embed industry-best practices, unique data sources, advanced analytics, and years of actuarial experience in our next-generation pricing models for self- and fully insured employers to provide actionable, validated, and impactful strategies for payers to effectively articulate and price the value created for members.
• Sales-force effectiveness - We use proprietary data, predictive analytics, and consultative selling capabilities to help payers drive sales-force effectiveness and seamlessly manage the last mile to brokers, employers, and ultimately - members.
• Product innovation - We leverage cutting-edge broker, consumer, and employer insights (for example, annual survey of 1,000 employers) to design customer-backed commercial offerings to improve experience, affordability, and minimize abrasion.
• Ancillary growth - We help payers develop unique, whole-health-focused value propositions across medical and nonmedical lines of business through our deep expertise in stop-loss, dental, vision, life, and disability insurance.

Digital Strategy & Transformation

Helping healthcare organizations to strategically employ digital and analytics to transform their businesses and dramatically improve performance The rise of big data and digital capabilities is changing the way healthcare payers and providers operate. We draw on an unrivaled mix of healthcare expertise and experience leading end-to-end delivery of digital transformations to help healthcare organizations improve healthcare cost, quality, and access from digital and analytics.

What we do

• Digital strategy - We help healthcare organizations understand the value at stake from digital technologies, prioritize key areas, and create road maps for transforming their organizations.
• Cost and performance enhancement - We help healthcare organizations to boost efficiencies through back-office process redesign and automation as well as to use digital workflows to drive efficiency in clinical operations and caregiver-experience redesign.
• Digitally enabled growth - We support healthcare organizations to improve member and patient acquisition and retention through sophisticated analytics and personalized engagement and boost brand loyalty through consumer strategies and digitally enabled journeys.
• Digital healthcare cost, quality, and access - We help healthcare organization to improve healthcare outcomes and value by supporting consumers and providers with digital tools as they make care decisions and manage their chronic conditions.
• Core technology - We help healthcare organizations to develop the technology foundations and capabilities—including agile at scale, DevOps, and modern architecture—to scale and sustain digital transformations.

Healthcare Consumer

Accelerating organizational performance and health outcomes through better patient engagement and experience. Health insurers have long recognized the importance of engaging members to improve the value of care. Yet efforts to date have rarely achieved the desired impact. The promise of member engagement throughout the care journey remains, however, and the underlying capabilities required to drive impact—especially data liquidity, advanced analytics, and digital solutions—are rapidly advancing. We help clients accelerate their organization performance and improve health outcomes.

What we do

• Consumer attraction and retention - We help healthcare organizations spot unmet consumer needs and enable them to deliver better experiences at the right time and place with the right product, message, and value proposition that lead to improved attraction and retention.
• Unrivaled stakeholder insights - We generate insights for stakeholders across the healthcare value chain—brokers, consumers, employers, and providers—to support improved business decision making and to develop a deeper understanding of healthcare stakeholders and how best to interact and engage with them.
• Improved patient engagement - We help improve patient health outcomes and total cost-of-care delivery by empowering consumers across channels to make better decisions and manage their health through personalized, omnichannel engagement.
• Seamless consumer experience - We support healthcare organizations in defining customer-experience vision, journey prioritization and redesign, and end-to-end delivery, resulting in enhanced consumer experience and outcomes , lower administrative costs, and improved medical costs, and we help identify digital and advanced analytics opportunities to improve consumer experience.

Healthcare Innovation

Improving quality and efficiency of healthcare through care delivery, network, and payment model innovation

What we do

• Payment innovation and transparency - We help payers, providers, integrated health systems, and state and federal governments design and manage value-based payment models and care programs. These include total cost-of-care and episode-based programs designed for the general population as well as more focused programs designed around target populations, specific episodes of care, and care journeys. Our team of healthcare experts, statisticians, data scientists/engineers, and actuaries employ industry-leading approaches to help clients evaluate and manage their portfolio of care management and value-based payment programs, measuring quality improvement, return on investment (ROI), and stakeholder satisfaction.
• Behavioral health - We develop solutions for payers, government agencies, and providers to improve treatment, care delivery, and payment systems for people with behavioral health conditions, including mental illness and/or substance use disorder. This includes better serving populations with serious mental illnesses as well as integration of behavioral and physical health care for broader patient populations.
• Long-term services and supports - We work with payers and providers to improve access, quality, and efficiency of long-term services and supports delivered to persons who need support with activities of daily living. This includes people who are eligible for Medicaid (including Medicare/Medicaid dual eligible) based on physical, intellectual, and/or developmental disabilities, and who receive long-term services and supports through nursing homes or other residential settings, day habilitation, or home and community-based services.
• Next-generation care management and care models - We transform care-model strategies, design, and operations for both payers and providers to deliver measurable return on investment across care delivery, outcomes improvement, and financial performance. We help clients design end-to-end care models for high-value patient segments and conditions using advanced analytics, digital tools, clinical expertise, consumer-engagement approaches, and operational excellence.
• Network design, optimization, and contracting - We help payers improve performance on quality, efficiency, and access to care through network portfolio strategy, network and contract design and optimization, contracting, and management of member incentives. We optimize the intersection value network and payment innovation. And, we deploy our approaches to the full range of providers, products and lines of business. We leverage advanced analytic methods and proprietary data sets and tools to help our clients improve measurement of provider performance and the design and management of their networks and contracts.
• Social determinants of health - We push beyond clinical and claims-based data and analytics by integrating data related to individual and community needs and behaviors. These analyses help to inform the design and delivery of healthcare solutions that address the full range of clinical and non-clinical drivers of healthcare outcomes and utilization. We help clients understand the value of these solutions, develop comprehensive strategies drawing from market intelligence on trends and best practices, assess gaps and opportunities using a range of quantitative and qualitative approaches, and support with capability-building, governance, and establishing cross-sector partnerships.

Medicaid

Driving innovation and sustainable improvement in Medicaid and dual eligibility for enhanced health outcomes, experience, and value creation. We draw on extensive industry knowledge; a deep pool of clinical, actuarial, policy, and technology experts; and advanced-analytics capabilities to help institutions across the Medicaid ecosystem deliver higher-quality healthcare at a reasonable cost to high-needs populations. We advise federal and state healthcare agencies, Medicaid health insurers, health systems, investors, and pharmacy benefit managers and have led projects in a variety of topics, including delivery, implementation, operations, organization, strategy, and technology.

What we do

• Innovation and transformation in state healthcare - Our support to state healthcare agencies extends across program redesign, waiver development, managed-care contracting and performance management, program governance, and value assurance on integrated eligibility systems (IESs) and Medicaid-management information systems (MMISs).
• Our work includes statewide, value-based payment-model - implementation; Medicaid-expansion planning; managed-care transition; and business-process redesign related to IT transitions.
• Medicaid managed-care-organization transformation - We help set and achieve ambitious agendas across growth, operational excellence, and innovation. Our work spans national and local organizations, provider-led entities, and organizations focused on addressing special needs populations (e.g., behavioral health, long term service and supports, and dual eligible individuals). We deploy analytics to support MCOs to identify the areas where they can best impact the quality and efficiency of care; expanding member access to high-value care; and enhancing member experience of care.
• Financially sustainable care delivery - We help health systems that serve Medicaid beneficiaries in transforming their care-delivery and financial-management models to provide optimal care.
• Investment and value creation - We support investors in creating value in the Medicaid ecosystem in a way that fits with their portfolio goals. Our work includes market scans prior to due diligence, asset due diligence, valuation, negotiation, and value capture after due diligence.

Medical Cost Management

Strengthening medical-cost portfolios, with the triple aim of improving healthcare affordability, access, and quality

What we do

• Payment integrity to safeguard patients and other stakeholders - We implement analytics and best practices to reduce fraud, waste, and abuse.
• Appropriate services for patients - We create new levers and strengthen policies and processes to manage service and supply utilization.
• Pharmacy-value-chain optimization - We refine access to appropriate medications and high quality of care at the best price.
• Care gaps and opportunities for heightened risk accuracy - We optimize systems and processes to prevent diagnosis and coding gaps, enhance case management, and patient outreach and education.

Medicare

Driving excellence in Medicare across the healthcare value chain. We draw on extensive industry knowledge, a deep pool of experts, and decades of service to the healthcare sector to support clients across the value chain and provide distinctive insights. Our teams collaborate with payers, provider systems, PBMs/pharmacies, private equity, third party solution vendors, and regulatory bodies to meet the challenges of an increasingly complex healthcare landscape.

What we do

• Local market analysis - We use census-tract and county-level analytics and Medicare Advantage–enrollment projections to determine growth opportunities for our clients. Using advanced analytics, we help inform competitive-product portfolios and marketing strategies to support organizations.
• Product portfolio and benefit design - We drive end-to-end design (or redesign) of product portfolios using both publicly available Centers for Medicare & Medicaid (CMS) data and client-claims data—our actuaries work hand in hand with client teams to develop actuarially sound product designs. We also help clients refine their portfolios via consumer research and simulations.
• Member-centric engagement - We drive growth across enrollment sources by deploying next-generation engagement strategies, including proprietary analytics to prioritize outreach and develop customized journeys based on consumer microsegments and member-level preferences. We also support clients on building commercial-partnership strategies to improve age-in conversion.
• Marketing and sales excellence - We perform rapid diagnostics and benchmarking across marketing and sales to identify opportunities to improve conversion and cost effectiveness, deploy channel-level strategies to segment and prioritize brokers, improve internal-agent performance, optimize digital marketing and engagement, and build capabilities for continuous improvement.
• Risk-coding improvement - We provide end-to-end support to improve risk-coding accuracy and completeness for Medicare Advantage payers and, ultimately, to improve patient care through better clinical documentation.

Payer Operations

Improving effectiveness, efficiency, service performance, and future capabilities for healthcare payers. We combine advanced tools and techniques with expertise in operations to help payers boost their operations and implement strategies that will stand the test of time. Our work helps payers address four imperatives:

• improve the quality of care and service for all stakeholders through more efficient and less error-prone operational processes
• deliver better experiences to patients and providers—for example, through use of self-service tools and improved customer service during direct interactions with members
• develop the future-state operations strategy and define the capability needs—for example, through use of automation and digitization to reimagine traditional processes using emerging technologies
• optimize the purchasing strategy and outside spend—for example, through leveraging of labor mix using a combination of business partnerships, outsourcing, and captive strategies

What we do

• Optimized administrative-cost spend and greater return on investments - We help plans develop capabilities and deliver superior customer experience while optimizing administrative spend. We also help them identify areas of opportunity within the payer value chain to get a fuller view on where to optimize costs and where to enable funding of other parts of the value chain that need advanced capability.
• Digitized operations, with a focus on technology enablement - We help payers fully leverage the opportunities of next-generation tools, analytics, digital penetration, and cognitive automation to improve productivity, quality, and customer experience. Through digital technologies, we deliver faster turnaround times for approvals and claims payments, proactively anticipate member and provider needs to improve stakeholder experience, and streamline care management operations to drive increased healthcare value.
• Operating-model strategies, capabilities, and improvement programs - We work with payers to develop specific actions and interventions that address the known gaps in capabilities and processes. Furthermore, we help payers set up governance structures to ensure an execution-focused mind-set and drive accountability. Our transformation playbooks help foster a culture of continuous improvement and an agile mind-set within the organization by helping the workforce gain appropriate skill sets and matching talent to value.

Performance Transformation

Helping healthcare businesses drive sustainable results by transforming performance through capability building, strategic repositioning, and technology enablement. A rapidly changing healthcare environment calls for action to transform. We support healthcare organizations from end to end across growth, performance, and innovation topics in a way that achieves sustainable results. Our proven approach and unequaled pool of expertise has helped distill the critical ingredients needed for organizations to achieve velocity in a transformation.

What we do

• Holistic transformation - We use a holistic, proven approach with unparalleled expertise to support large-scale, structured transformation programs to drive growth, spur innovation, and turn around operational performance of payers, providers, and healthcare-services organizations.
• Performance improvement - We tailor our transformation approaches to a healthcare organization’s situation and goals, and work with an organization to alter its performance, health, and capabilities completely when the aspiration is a radical step up in performance. In other instances, we apply a unique approach that provides flexibility but still generates significant improvement in execution, capability, and growth.We frequently conduct M&A and strategy transformations in targeted situations.
• Opportunity identification - We have considerable experience in conducting diagnostics across functional areas to understand transformation opportunity at a granular level. We complement our hands-on work with proprietary, rapid diagnostic tools and concepts that tackle a range of healthcare challenges. Further, we use a proven recipe of practices and governance to ensure that the identified opportunities progress from ideas to well-developed implementation plans to support healthcare organizations.
• Implementation - During the implementation phase of a transformation, we engage experts in growth, consumer journeys, digital, corporate finance, supply chain, back-office functions, patient access, and clinical operations alongside dedicated delivery and implementation resources (including interim management, when appropriate) to drive differentiated levels of performance and growth.

Pharmacy Services

Enhancing patient outcomes, driving healthcare-delivery efficiencies, and developing effective strategies across the pharmacy value chain. Several important trends are reshaping the pharmacy industry, altering the value pools and basis of competition within it. Through a holistic view on the pharmacy value chain, we have enabled retail pharmacies, wholesalers, pharmacy benefit managers (PBMs), providers and payers to rethink inflection points, areas of focus, and disruption over the coming years.

What we do

• Strategic planning for disruptions in the value chain - We assist organizations through the development of their go-forward strategy as they navigate potential regulatory and competitive disruption in the pharmacy-services industry.
• Healthcare-delivery efficiency through improved quality and medication management - We guide the design and implementation of pharmacy-services solutions across a range of levers, including lean optimization, demand management (for example, streamlining a prior-authorization list), digital automation (such as building intelligent web intake and technology-enabled reviews), and improved organizational culture and processes.
• Effective planning and management of pharmacy costs - We help organizations better manage their pharmacy spend through a combination of predictive analytics, proprietary data sets, and implementation expertise (from contracting to process design).

Provider Performance

Helping healthcare providers transform performance in labor, external spend, clinical operations, and capital through our unique combination of deep industry experience, advanced analytics, and cutting-edge tools. Our team of physicians, nurses, data scientists, product designers, and system engineers are committed to supporting healthcare providers as they help clients navigate an increasingly complex healthcare landscape. While working to boost their performance, we also help them build the health of their organization to sustain long-term excellence.

What we do

• Performance-improvement-opportunity diagnostics - We rapidly diagnose and identify performance-improvement opportunities across labor, external spend, capital, and clinical operations by deploying our proprietary tools and analytical capabilities.
• End-to-end supply-chain transformation - We help redesign supply-chain organizations and processes, support contracting to reduce unit cost, identify opportunities to drive out inefficiencies, support implementation of utilization-based initiatives and related clinical-engagement structures, and assist in performance management and capability building to promote sustainability.
• Workforce-composition and -spend optimization - We take a holistic focus on labor, recognizing that it is the people in an organization who drive culture and experience, while also ensuring the safe delivery of high-quality patient care. Our experts, proprietary tools, proven transformation approaches, and capability-building focus enable us to support healthcare organizations in a highly tailored way and achieve their workforce objectives, from reducing workforce turnover to optimizing staffing efficiency to empowering clinicians to practice at the top of their licenses.
• Capital-expenditure strategy for construction and medical equipment - We support construction projects end to end, including strategic alignment, design, procurement, and execution. Our clients typically save 10 to 20 percent of in-scope capital expenditures while increasing on-time delivery, improving customer experience, and maintaining flexibility. Additionally, we help optimize the process for medical-equipment procurement.
• Clinical-operations improvement through technology and analytics - We diagnose, design, and implement changes in clinical-operations models to improve the quality, efficiency, and cost of care across delivery settings (such as emergency departments, operating rooms, inpatient services, ancillary services, outpatient clinics, and ambulatory surgery centers). We help enable rapid improvements in clinical performance through use of our proprietary advanced analytics, performance-management systems, and proven operational toolkits.

Provider Revenue Excellence

Enabling health systems’ top-line performance through proven analytical- and technology-enabled operations approaches to growth, pricing, and yield realization. Health systems face mounting pressures against top-line performance, including a greater range of sites of care competing for consumers’ utilization, an increasingly complex payment process, and declining reimbursement escalators for services rendered, that pressure top-line performance. We draw on our extensive industry experience and pool of experts to provide distinctive insights and deploy proven analytical and tech-enabled operational approaches to support health systems.

What we do

• Holistic approach to revenue excellence - We partner with health systems to earn appropriate patient volume across all sites of care; ensure that payer contracts provide a fair unit price; design effective, value-based agreements; and achieve optimal yield realization through the revenue cycle for services rendered.
• Increased share of addressable markets - We bring expertise to health systems on asset-footprint strategies, clinical program and workforce development, continuity of care, and more, using a comprehensive approach to the operational activities that support appropriate volume growth.
• Improved partnerships with payers - We bring distinctive capabilities, including a focused approach to aligning contracting outcomes with operations, that enable health systems to excel along the full managed-care-contracting life cycle.
• Optimized end-to-end revenue-cycle performance - We use ready-to-deploy assets, playbooks, and practical experience across the revenue cycle to ensure optimal yield realization while maximizing important, adjacent variables, including patient experience, cost to collect, and cash flow.