Health Care Payers, Providers, Systems & Services

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 struggle to bend the cost curve. BCG’s Center for Health Care Value offers tailored solutions to health care systems seeking to adopt value-based health care principles. We work with ICHOM, the World Economic Forum, and other partner organizations to drive a common agenda for change.