High Performance Health Plans Research

Our experts evaluated the performance of major for-profit health plans over the most recent three industry cycles to gain insight into the characteristics of health plans performing consistently at the highest level.

To support our direct experience across the Health and Life Sciences industry, we undertook research to isolate what it takes to be a high-performance Health Plan. In our research, we identified a common set of traits and behaviors that characterized these high-performance health plans. They relentlessly manage current value, driving for consistent performance improvement. At the same time, they build the future firm, innovating their product lines and business model. Across both time frames, they secure internal and external business insight that they turn into action to gain value for customers and shareholders.

Our analysis identified a small number of consistent winners over each cycle that share common attributes.

• Between 1990 and 1995, the winners were able to deliver on increasingly tightly managed care or a niche focused on more open networks.
  
  
• Between 1995 and 2000, the winners were those with product flexibility and more open models.
  
  
• Between 2000 and 2003, winners were those with superb administrative cost management skills.

All of these health plans share a relentless focus on business insight, continuous performance improvement and growth. When it comes to business insight, they empower their organizations with critical business information including leading, coincident and lagging business indicators, shortening cycle times from insight into action. In addition, they anticipate and respond to market shifts, enabling a greater focus on producers, segments and customers.

Looking at cost management, high-performance health plans commit to continuous performance improvement in administrative costs, medical management and technology infrastructure. They also leverage partnerships and alternative business models. Finally, high-performance health plans pay particular attention to their growth engines. They drive for scale, pursue organic growth with innovative segment and product strategies and also pursue selective acquisitions consistent with prudent growth strategy.