Point of View

Healthcare’s ever-changing market and continuously evolving enablers and disruptors are driving toward an outcomes and delivery-based model. As critical players in the market respond to these trends and challenges, key drivers must be understood and addressed.

• Healthcare reform will continue to force regulatory change focusing on quality care, guaranteed issue, and cost.
• Payer products must evolve to meet unmet consumer needs, focusing on simplification, quality, affordability, and personalization.
• Care management is necessary to grow the payers' focus from transactional excellence to servicing members' health needs.
• Consumer buying channels will evolve to include new marketplaces such as Exchanges and Co-Ops.
• Government sponsored health program changes will shift delivery of care models, increase covered and subsidized members, and require substantial compliance and audit measures.
• IT capabilities and innovative technology solutions are the route to efficiently and effectively meeting market demands.
• Market consolidation will continue, given the new regulatory, product, and financial resource requirements.
• Outcomes delivery requires a new operating model, focused on service excellence, evidence-based information, and trust.