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Health Care

The US Health Insurance sector is in a constant state of motion. While managing through backlash-driven evolution from managed care to less restrictive product offerings, the sector is experiencing a revenue and profit cycle that is more favorable than anything it has seen in many years.

Yet, with total US health care expenditures now rising above 14% GDP, commercial health insurers have come under increased scrutiny - (i) by the federal government that wants to find ways to increase health care insurance participation without increased spending, (ii) from state Attorneys General who are examining insurers' relationships with external sales channels, (iii) from employers, employer coalitions like Leapfrog and local regulators that are concerned about excessive profits inuring to insurers, especially not-for-profit insurers and (iv) from consumers, many of whom are concerned about ever-rising health care costs compared to their incomes.

The sector is and has been experiencing 5 important trends - the 5 C's:

  • Competition - increasing within the sector itself and from well-financed interlopers like multi-line TPAs, Hewitt, Fidelity and TD Waterhouse
  • Capitalism - the steady shift from mutual and not-for-profit to for-profit and, for some, publicly traded status - gaining access to capital, increasing ability to compete and creating new economic value for owners
  • Consolidation - where insurers develop and implement strategies to: acquire or be acquired, create economic leverage and generate accretive results; or to resist acquisition, necessitating new approaches to create revenue, cost and operating leverage - such as multi-insurer shared services solutions and highly outsourced, virtual structures
  • Consumerism - somewhat distorted by the recent emphasis on controlling employer premiums and costs, this inevitable trend will fundamentally change insurers' products, sales and marketing approaches, core competencies, structures, services and technologies
  • Cost management - focused on reducing overall medical and administrative cost trends, insurers will evolve to financial services models - straight-through transaction systems without human intervention, outsourced processes and services where appropriate, cooperative solutions even with competitors for selected processes and technologies, and adoption of new business structures over time

Questas Consulting is uniquely positioned to help health insurers realize their transformational and transitional objectives because we understand this industry and how to effectively plan and manage the transitional activities that produce the results that count.

Our Services for Health Care

  • Top-Line Growth
  • Business & market strategies
  • Market segmentation analysis
  • Product development
  • Distribution channel effectiveness assessments
  • Client retention strategies
  • M&A and M&A defense strategies
  • Pre- and Post-Merger/Acquisition planning - due diligence, synergy opportunity analysis, transition and integration planning
  • Strategic partnering assessments
  • Change Management
  • Executive coaching and succession planning
  • Strategic Alignment
  • People - Process - Technology Alignment
  • Strategic Intent Confirmation and Commitment
  • Leadership Capability Aligned and Developed
  • Goal Translation Facilitated
  • Performance Objectives and Measures Established
  • Reward Practices Aligned
  • Organization design and behavior assessments
  • Large-scale Program Management
  • Transition management
  • Process & Service Excellence
  • Diagnostic assessments
  • Service modeling
  • Portfolio rationalization
  • Strategic IT & E-commerce/E-business strategies
  • Effective Enterprise-level Transformations - operational, cultural, organizational, technological
  • Process-focused organizational model
  • In- and out-sourcing - process (BPO) and IT (ITO)
  • Consolidations & intra- and inter-company Shared Services models
  • Merger & acquisition implementations
  • Turnarounds & divestitures
  • Adaptation to new business models
  • Effective Process-level Transformations
  • Processing engineering & management
  • Metrics development
  • Staff modeling
  • Cost Management
  • Validation of medical cost management vs. benefits
  • ABC/ABM and unit cost allocations
  • Outsourcing - BPO and ITO
  • Intra- and Inter-company shared services
  • Process engineering and automation
  • Overhead cost reduction programs
  • Staff modeling
  • Technology
  • Strategy
  • Application assessment and selection
  • Evaluation and application of BPM tools
  • Developing competencies - analytics & informatics
  • E-business and E-commerce implementations
  • In-/ outsourcing of IT - ITO

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Health Care Clients

  • Anthem Inc.
  • Blue Cross Blue Shields of MI, MA, MN, RI, TN
  • Delta Dental of Minnesota and DeCare International
  • Delta Dental of Massachusetts and DentaQuest Ventures
  • Excellus BCBS
  • Health Care Service Corp (HCSC) - the Blue Cross Blue Shield Plans of IL, TX and NM
  • Hoffman LaRoche
  • Kaiser Permanente
  • Leprechaun
  • Montefiore Hospital
  • Neighborhood Health Plans
  • Pfizer
  • Premera
  • Trigon (now Anthem of VA)
  • Wellmark Blue Cross Blue Shield
  • Wellpoint