Bill Frack

Through over-reimbursement and under-reimbursement, Medicare Advantage — the first real “retail” health insurance market of scale — has consistently penetrated the Medicare marketplace over the past 20 years. And it shows no sign of slowing down.

For payers, that means finding ways to drive growth of their Medicare Advantage offering. For providers not already contracting with Medicare Advantage, it’s time to bite the bullet and either figure out an effective business model or consider… Show more

Through over-reimbursement and under-reimbursement, Medicare Advantage — the first real “retail” health insurance market of scale — has consistently penetrated the Medicare marketplace over the past 20 years. And it shows no sign of slowing down.

For payers, that means finding ways to drive growth of their Medicare Advantage offering. For providers not already contracting with Medicare Advantage, it’s time to bite the bullet and either figure out an effective business model or consider launching their own plan. For investors, this is a macro trend and as such, a long-term opportunity. Show less

In healthcare, higher retention rates are critical to successful care management since a plan can only influence its members’ health over the long term. Improved retention rates also may result in members who are more satisfied with their existing insurance and therefore more likely to recommend the plan to others, reducing the costs of bringing in new customers.

Despite retention’s critical importance, many health plans treat the issue superficially. As it is easier to focus on sales… Show more

In healthcare, higher retention rates are critical to successful care management since a plan can only influence its members’ health over the long term. Improved retention rates also may result in members who are more satisfied with their existing insurance and therefore more likely to recommend the plan to others, reducing the costs of bringing in new customers.

Despite retention’s critical importance, many health plans treat the issue superficially. As it is easier to focus on sales and marketing campaigns, health plans have not drilled down into the complex issues that cause disenrollment, nor have they implemented comprehensive strategies to improve retention.

In an earlier Executive Insights, L.E.K. pinpointed the root causes of health plan disenrollment and discussed a method for strategically accessing these root causes and the way they combine to impact retention. In this Executive Insights, L.E.K. Consulting’s Healthcare Operations Expert Tom Rekart and Managing Director Bill Frack take the next step by focusing on implementation. The authors identify the most effective initiatives for increasing retention, and lay out how these initiatives should be coordinated and prioritized.
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One growing crack in the foundation of our healthcare system is caused by the misguided incentives that reimburse care providers for individual patient visits and treatments rather than the overall improvement of patient care and wellness. To better align payers and providers, one key element of federal healthcare insurance reform is the creation of Accountable Care Organizations (ACOs), which are designed to unify a broad spectrum of care providers and establish incentives for them to work… Show more

One growing crack in the foundation of our healthcare system is caused by the misguided incentives that reimburse care providers for individual patient visits and treatments rather than the overall improvement of patient care and wellness. To better align payers and providers, one key element of federal healthcare insurance reform is the creation of Accountable Care Organizations (ACOs), which are designed to unify a broad spectrum of care providers and establish incentives for them to work collaboratively to address patients’ overall health.

However, plans to establish ACOs frequently stall because payers and providers are struggling to agree on a program framework. L.E.K. Consulting’s new report addresses how payers and providers can establish metrics that enable all ACO partners to succeed. The report includes:

- Seven hurdles to ACO adoption (quality metrics, incentives, governance, etc.)
- Keys to successful collaboration between payers and providers
- Best practices for planning next steps in ACO development
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Many brands are responding to market pressures by trimming prices and implementing aggressive promotional campaigns to attract and retain customers. While sales during the short term are certainly important, consumer products executives must also carefully consider their pricing strategies to ensure they remain competitive without tarnishing their brand over the long term.

There are steps that companies should take today to ensure that their current pricing strategy is consistent across… Show more

Many brands are responding to market pressures by trimming prices and implementing aggressive promotional campaigns to attract and retain customers. While sales during the short term are certainly important, consumer products executives must also carefully consider their pricing strategies to ensure they remain competitive without tarnishing their brand over the long term.

There are steps that companies should take today to ensure that their current pricing strategy is consistent across all channels, and that they have the agility to address competitive changes rapidly. L.E.K. Consulting has identified four best practice ideas that senior executives should consider as they work to maximize profits and reinforce brand positioning. Take our pricing strategy test to help you gauge the relative performance of your organization's pricing strategy.
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The Medicaid managed care market is exploding. Revenue is expected to more than triple from approximately $90 billion to $290 billion between 2010 and 2017. The sources of growth from Medicaid managed care expansion are the result of three primary drivers:

-Massive increase in managed care penetration
-Rapid increase in the number of people eligible for Medicaid
-Shift in the populations served by Medicaid

To survive and thrive in this new world order, payers must be… Show more

The Medicaid managed care market is exploding. Revenue is expected to more than triple from approximately $90 billion to $290 billion between 2010 and 2017. The sources of growth from Medicaid managed care expansion are the result of three primary drivers:

-Massive increase in managed care penetration
-Rapid increase in the number of people eligible for Medicaid
-Shift in the populations served by Medicaid

To survive and thrive in this new world order, payers must be aggressive in order to meet the shift in state program requirements. In this Executive Insights, we draw on our experience to detail six points that Medicaid payers should focus on in order to win RFPs and maximize profit potential in this growing Medicaid managed care environment.
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After failing dramatically in the late 1990s, Physician Practice Management companies (PPMs) are back. After two decades of healthcare industry evolution,
PPMs have a strong value proposition. The sequel to the PPM drama is likely to be more successful than the original – as long as PPMs adopt several key tactics to make PPM ventures succeed.

In a new Executive Insights, L.E.K. Consulting’s Bill Frack and Nurry Hong call on years of experience in the PPM space to defend the… Show more

After failing dramatically in the late 1990s, Physician Practice Management companies (PPMs) are back. After two decades of healthcare industry evolution,
PPMs have a strong value proposition. The sequel to the PPM drama is likely to be more successful than the original – as long as PPMs adopt several key tactics to make PPM ventures succeed.

In a new Executive Insights, L.E.K. Consulting’s Bill Frack and Nurry Hong call on years of experience in the PPM space to defend the proposition that conditions favor a PPM resurgence. They lay out the key strategies for PPM success in the current environment and argue that the arrival of the next generation PPMs will provide many opportunities across the healthcare value chain; in this new chapter, everyone from payers to private equity investors can position themselves to benefit.

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Although the metrics for health plan member retention success are clear, the formula for reducing disenrollment is highly elusive. Despite the integral role that retention plays in a health plan’s long-term financial performance, many health insurers can’t accurately identify the top reasons why members leave their plans, and are unable to address the problem effectively.

To help health plans address the challenge of reducing disenrollment, L.E.K. Consulting has detailed its approach to… Show more

Although the metrics for health plan member retention success are clear, the formula for reducing disenrollment is highly elusive. Despite the integral role that retention plays in a health plan’s long-term financial performance, many health insurers can’t accurately identify the top reasons why members leave their plans, and are unable to address the problem effectively.

To help health plans address the challenge of reducing disenrollment, L.E.K. Consulting has detailed its approach to developing accurate and actionable insights into the true root causes of why their members leave. The new Executive Insights report includes:

- Calculating retention return on investment (ROI)
- An overview of the two steps to identifying disenrollment drivers
- Case study examples
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Like all M&A activity, deciding if, when, and in what form to separate some part of a company's assets needs careful objective analysis to determine what action will create the most long-term value for shareholders. This newsletter provides key insights into structuring analyses for equity separation propositions and shares L.E.K. Consulting's experiences with both traditional companies trying to maximize their often undervalued technologies and new economy businesses looking to develop the… Show more

Like all M&A activity, deciding if, when, and in what form to separate some part of a company's assets needs careful objective analysis to determine what action will create the most long-term value for shareholders. This newsletter provides key insights into structuring analyses for equity separation propositions and shares L.E.K. Consulting's experiences with both traditional companies trying to maximize their often undervalued technologies and new economy businesses looking to develop the most appropriate entities for facilitating growth and attracting capital. They offer the reader a pragmatic framework for measuring risks and rewards, and determining what the appropriate alternatives should be. Show less

Looming federal mandates will require payers and providers to adopt a new framework to measure patients’ overall health and wellness. L.E.K. Consulting’s new report covers seven critical factors for establishing a viable and efficient accountable care organizations (ACOs) that will address holistic care:

- Reassess market needs
- Create and administer new care models
- Institute incentives focused on holistic patient care
- Integrate clinical data
- Ensure seamless transition… Show more

Looming federal mandates will require payers and providers to adopt a new framework to measure patients’ overall health and wellness. L.E.K. Consulting’s new report covers seven critical factors for establishing a viable and efficient accountable care organizations (ACOs) that will address holistic care:

- Reassess market needs
- Create and administer new care models
- Institute incentives focused on holistic patient care
- Integrate clinical data
- Ensure seamless transition of care
- Measure performance
- Educate consumers about new care models
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