Payer Strategy

Payer Strategy

Increase revenue and margin by deciding where to focus and how to win.

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How We Deliver Value

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When evaluating growth opportunities, companies can consider expanding their geographic footprint, entering new segments, or launching differentiated products or services​.

Mature, heavily regulated markets create the need for companies to drive growth through innovative offerings​.

Emerging Markets

Relatively immature markets that are facing a great deal of expansion due to increased consumer growth or demand.

Established Markets

Long-standing markets with entrenched competitors and stabilised consumer demand. 

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Companies are looking to M&A to expand their market share and grow delivery and technology capabilities. Significant planning and alignment around M&A strategy, acquisition criteria, and realistic synergies are essential to driving a successful transaction and integration.

We help clients with market scanning and pre- and post-integration planning. (We do not perform due diligence or transaction management services.)

Business teamwork

Companies are always examining how to create a sustainable delivery method that enables leading class outcomes for consumers.

Competitive markets require companies to understand how they can optimize for the best dollar against competitors based on predictions of what they might do.

Examples in Healthcare

Transparency in Coverage: Stakeholders in healthcare can leverage cost transparency to their advantage in different ways. Health plans can utilize this information to achieve lower rates. Providers can utilize this information to increase their rates.

Network: Health plans must carefully design networks to steer membership towards providers in which they have discounted rates.

Provider: Assessing different reimbursement models and care structures between providers and alternative sites of care can improve overall spend.

Care Management: Care management services can be used to steer patients towards time saving, cost-efficient resources that may lower overall spend and improve health outcomes.

Rx: Pharmacy utilization management and pharmacy unit cost levers can be used to reduce Rx spend. 

Our Leaders

Vijay Murugappan
Joshua Pierce

Our Leaders

Vijay Murugappan - Payer Services Practice Lead

Vijay is a passionate advocate for a healthcare system that delivers quality health outcomes at appropriate cost. Through a rich set of experiences in various disciplines (organizational strategy and process improvement, sales, revenue and profit management, analytics, operations) across multiple industries (healthcare, retail, consumer products, high tech, government, and logistics), Vijay has built teams that come together with a common purpose, a sense of trust and respect, and a maniacal focus on customer success to deliver outstanding business results.

Joshua Pierce - Payer Solutions Expert

Joshua is an industry expert who has a deep understanding and professional experience across the length and breadth of the healthcare value chain, from building talented analytics teams for population health leaders to consulting for major national health plans and advising Fortune 500 clients on employee healthcare plans. He has a successful track record in implementing, analyzing, and optimizing programs across the full spectrum of digital and traditional healthcare solutions.