Managing Director & Senior Partner, Global Sector Leader, Health Care Payers, Providers, Systems & Services
San Francisco - Bay Area
The health care industry is facing transformational changes. To thrive in a postpandemic world, health care leaders must build on their innovative responses to COVID-19 and develop new initiatives to reposition—and reimagine—their organizations for the future.
The health care payers, providers, systems, and services landscape is being transformed. Digital engagement models are proliferating, with many patient journeys now beginning online. Health equity is becoming a priority for every organization that is serious about health outcomes. Site of care is continuing to shift from inpatient or hospital settings to outpatient facilities—and, where possible, to the home. Data and analytics are enabling greater agility and innovation in health care. And the basis of competition is moving toward ecosystems of players, including public sector, biopharma, medtech, and technology companies.
BCG’s experts in health care strategy consulting are helping clients develop transformative solutions to their most pressing challenges and deliver outstanding value and positive change for organizations, patients, and society.
The integration of payer and provider systems is one of the most dynamic aspects of the health care market today. The line between sectors is blurring as cross-sector collaboration accelerates and cross-sector acquisition activity increases. Some payers are acquiring their own hospitals, while providers are adopting their own insurance models. Payer and provider collaboration and integration are essential to improving disease prevention and increasing the focus on therapies that deliver better health outcomes.
COVID-19 has reshaped health care. It has accelerated the growth of digital ecosystems and—by further exposing the risks of fee-based medicine—increased adoption of value-based care. At the same time, it has upended the profit pools for both payers and providers, widening the gap between small and large businesses. BCG helps organizations navigate this shifting landscape.
Digital solutions—such as telemedicine, remote monitoring, and a digital front door—can dramatically improve the patient experience. BCG helps clients make the right decisions about digitizing the patient journey and how to win.
Leading health care organizations are creating extraordinary value by digitizing their core and becoming bionic—that is, seamlessly bringing together humans and machines. Many have made progress toward becoming bionic but still have a long way to go to catch up with the trailblazers.
Big data, advanced analytics, and predictive analytics offer an opportunity to bring together diverse data sources and develop a truly value-oriented understanding of health. BCG provides patient-level data to clients and applies the health care analytics know-how to generate critical insights.
Agile is a way of working—and thinking—that is more collaborative, open, creative, and efficient than other models. For payers, agile ways of working can double the speed to market and increase customer satisfaction by 10% to 20%.
Value in health care is generated by delivering better health outcomes at the same, or even lower, cost. We have identified pragmatic interventions that hospital leaders can use today to reduce costs, protect the core, and deliver value-based care.
Improving payer operations—with an explicit focus on creating value—is critical for driving sustainable growth. We work with payers to achieve operational excellence, IT innovation, delayering, change management, post-merger integration, and profitability improvement.
Health care systems around the world are facing immense pressures: the changing nature of disease burdens, digital disruption, citizen expectations of care, and cost growth. We work with more than 50 national and regional governments around the world, tackling these challenges through large-scale change management, value-based health care implementations, data and digital transformation, payment reform, and operational transformations of government health agencies, ultimately helping them drive more effective strategy and organizational performance. Our Center for Health Care Value serves as a global thought leader in the adoption value-based health care principles across all players of the health care system. In addition, we cofounded ICHOM, the International Consortium for Health Outcomes Measurement; we also work with the World Economic Forum and other partner organizations to drive a common agenda towards more value-based systems.
BCG has a variety of proven benchmarks, tools, and frameworks to help health care payers, providers, systems, and services achieve growth and increased value.
CARE by BCG:
Demand Planning in Health Care
CARE by BCG helps health care systems plan for their needs today and well into the future.
BCG is helping health care payers, providers, systems, and services thrive in a market defined by increased complexity, tighter regulation, and breakthrough digital technologies.
Digital Giant Develops Health Care Services Model. BCG worked with a digital giant based in China to build an offline and online health care services model, based on an in-depth understanding of policy trends, consumer needs, and competitor dynamics. The innovative business model was well designed and immediately put into pilot.
European Payer Identifies 2.3% in Savings. Using AI and advanced analytics to better understand patient journeys and intervention measures, BCG helped a large European payer optimize care management while identifying savings of 2.3% of total claims.
Leading Health System Delivers a Groundbreaking Product. BCG worked with a large health system to transform its technology—and its care. Applying human-centered design and an agile approach put a groundbreaking product into the hands of patients within a year. The new digital front door is now used by over 500,000 patients to find, manage, and pay for care with the click of a button.
Middle Eastern Country Delivers Health System Reform. A Middle Eastern country faced high health care costs, significant variation in quality of care, and large gaps in services. Working with stakeholders across 60 initiatives, BCG collaborated with the country’s Ministry of Health to design a national, value-based health care system that could deliver better patient outcomes and better access while curbing cost growth.
BCG’s experts on health care payers, providers, systems, and services partner with leading companies to develop solutions in managing health care costs and quality, health system strategy, innovation in health care, payer operations, and more. The following are our global and regional leaders in this area.
Some of BCG's best advice to help provider, payer, biopharma, and medtech executives address the challenges and changes affecting the health care sector.
What challenges does the future hold for a fast-evolving sector that has undergone decades of change in the past 18 months?
Open-market business models—including exchanges, platforms, and hybrids—can transform the US health care industry, leading to more efficient, convenient, and cost-effective care.
Payers that take a tailored PMI approach and follow six imperatives for success will be well positioned to achieve the strategic objectives of their M&A.
Organizations must build on the momentum from their response to the crisis, delivering better care at lower overall cost and becoming more resilient to future disruptions.
With the right strategic thinking, health care systems will finally succeed in delivering the benefits that consumers have come to expect from other industries.