The Challenges of Facing Integrated Health Management for a Leading Insurer

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CASE STUDY

The Challenges of Facing Integrated Health Management for a Leading Insurer

THE CHALLENGES OF FACING INTEGRATED HEALTH MANAGEMENT FOR A LEADING INSURER WWW.FULD.COM

One Door Closes and Another Opens

A major insurer considering entering the integrated health management (IHM) market wanted to understand what competitors were offering in the space. Fuld + Company, bringing extensive experience in the health insurance industry, analyzed the strengths and weaknesses of those competitors, their positioning, their strengths and weaknesses, and their messaging. Finding a highly fragmented market with few best practices and formidable obstacles in the way of payer-led IHM, Fuld was able to offer an alternative strategy, closely related to IHM, along with recommendations about how the company could leverage its strengths in executing that strategy.

Case Overview

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The Promise of IHM Key Business Challenges

IHM proactively integrates health promotion and health protection of individuals to comprehensively reduce their risks over their lifetimes and help lower health care costs. Emphasizing prevention, health maintenance, and early intervention, IHM offers an alternative to the disease-driven approach to care that is largely reactive, impersonal, and highly expensive.



An Obstacle Course for Payers Key Business Challenges

As our extensive research demonstrated, payer-led IHM, in which the insurer manages the health of an insured population, faces some difficult hurdles, including a hard-to-prove value proposition, a long payback period, and the complexities that arise from health care providers using multiple payers. The emergence of public and private healthcare coverage exchanges may also be hampering adoption of IHM by diverting employers to other cost-reduction solutions.



Finding a Way Over the Hurdles The Fuld Approach

While we found some trends – like the movement towards health status trends and quality outcomes – that might give IHM some traction in the large group market, no insurer has effectively differentiated itself or demonstrably overcome the obstacles to payer-led IHM. We provided the client with detailed analyses of competitors and recommended an alternative strategy that, although much like IHM, overcomes some of its hurdles for insurers by aligning the interests of payers and providers.



Ready to Create a Path through Uncertainty Key Business Impact

The client is now positioned to make a more informed strategic decision about the IHM market. In addition, our analysis of competitors and our recommendations about how to leverage the client’s strengths and shore up its weaknesses provide guidance in a murky and uncertain market.



Delivering on our Commitment to Candor The Fuld Review

As this project unfolded and it became clear that the IHM market was problematical, with few best practices and little differentiation among competitors who were testing the space, the focus shifted. Drawing on our commitment to complete candor with all of our clients, we directed the client’s attention to what we believed was a more promising course of action. Although the client had neither previously considered that strategy nor sought information about it, they have now have options that can help them crack the code of a very challenging market.



Think a similar solution could work for your organization?

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About Fuld + Company

WHO WE ARE

Since 1979 Fuld + Company have pioneered competitive intelligence, and today we work with leading companies worldwide to deliver the competitive and market insights they need to make better business decisions. We don’t rest on our history and past successes. This means working hard to deliver uncompromising analysis that generates sound advice and earns us enduring partnerships with our clients.

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We are driven to expose our clients to insights about their industry, their competition and a changing market; designed to help avoid surprises and industry shocks. Through deep research, penetrating analysis and strategic gaming + advisory expertise, our team of professionals help you identify and solve tactical and strategic challenges. We help reduce the risks associated with business-critical decision making.

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Healthcare

The Challenges of Facing Integrated Health Management for a Leading Insurer