Payer Operations

We combine advanced tools and techniques with expertise in operations to help payers boost their operations and implement strategies that will stand the test of time. Our work helps payers address four imperatives:

• improve the quality of care and service for all stakeholders through more efficient and less error-prone operational processes
• deliver better experiences to patients and providers—for example, through use of self-service tools and improved customer service during direct interactions with members
• develop the future-state operations strategy and define the capability needs—for example, through use of automation and digitization to reimagine traditional processes using emerging technologies
• optimize the purchasing strategy and outside spend—for example, through leveraging of labor mix using a combination of business partnerships, outsourcing, and captive strategies

We offer payers a wide range of innovative tools and capabilities.

Comprehensive assessment of current-state capability: Proprietary methodology using our payer-value-chain taxonomy allows us to conduct a granular capability assessment across all functions and subfunctions to identify capability gaps and the potential impact of addressing the identified gaps.

Operational key performance indicators: We use a detailed set of financial, operational, staffing, and utilization metrics from more than 35 organizations, segregated by business segments, to identify cost-optimization opportunities and drivers of variation in functional performance rapidly.

Strategic roadmaps: We help payers conduct rapid ideation and create effective governance structures—as well as enable rapid execution on identified opportunity areas. We also leverage a repository of more than 350 interventions, spanning all general- and administrative-cost areas, administration functions, and subfunctions of the payer value chain—each with implementation best practices, valuation methodologies, milestones, and key performance indicators for rapid deployment.