Helping Healthcare Insurance Provider Navigate a Transforming Marketplace

Situation Analysis:

A major regional healthcare insurance company was unsure whether or not to participate in the new Affordable Care Act market exchange. If they were to participate, the insurer needed to establish product offerings that complied with the government mandate, which involved certain major uncertainties. In addition to regulation compliance, the company needed to engineer a competitive entry into the market: One in which their product offerings were appropriately priced so that they could attract the right number and range of consumers.

Discovery & Solutions:

Our approach to the Insurer’s multiple “big bets” was specifically designed to assess and manage the considerable uncertainty in this rapidly transforming market. Once we helped the company to determine that they were ready to enter the market, we focused on managing risk in three distinct areas:

  • Pricing structures for the company’s various new product offerings;
  • Risk mitigation surrounding the health and size of its new customer base. The new system abandoned conventional strategies in favor of an approach that focused on working directly with the new healthcare plan enrollees in order to address their health issues earlier and more efficiently; and
  • Risks associated with the company’s network of providers, which spanned an entire region of the U.S.

Results & Impact:

This three-tiered approach succeeded in helping the insurer preemptively and confidently address major uncertainties, which allowed it to effectively compete within this new healthcare market. While the company’s success is still evolving, preliminary polling of new exchange enrollees indicate that our recommendations and decision-making processes have helped the client deliver superior coverage to its new customers, as well as position itself strategically in a marketplace that is continuing to transform.