Payer+Provider Syndicate experts have participated in a wide range of engagements across the payer and provider sectors. The representative examples below illustrate the types of strategic, analytical, and operational questions we help clients address, including market assessment, vendor and partner evaluation, and performance improvement.
Representative and anonymized: the examples below are intended to show the breadth and character of prior work rather than to identify specific clients.
Payer and provider experience
Our work spans health plans, health systems, investors, service providers, and advisory firms serving healthcare clients.
Strategy, diligence, and operations
We support decisions related to growth, product strategy, partnership selection, diligence, workflow improvement, quality, and financial performance.
Market Assessment
We help clients understand demand, competitive dynamics, customer behavior, and the strategic implications of market change.
Representative payer engagements
- Assisted a payer in assessing market needs for non-insurance products
- Conducted survey and focus-group research to identify levers for improving customer satisfaction, supporting a regional payer’s achievement of a 4-star NCQA rating
- Examined county-level medical loss ratios, market share, and broker commission agreements to clarify the determinants of performance for a national payer
- Analyzed a regional payer’s book of business to anticipate the effects of expanding health insurance exchanges
- Advised an external consulting firm on how payers are utilizing mobile health technologies
Representative provider engagements
- Advised an external consulting firm on hospital formulary decision-making to support pharmaceutical pricing strategy
- Advised an external consulting firm on the current and potential impact of mobile health on population health management
- Advised a large investor on the implications of a strategic alliance between a health system and a diversified services provider
Vendor and Partner Evaluation
We help clients assess vendors, programs, and potential partners through an independent strategic, operational, and financial lens.
Representative payer engagements
- Evaluated a range of incentives that a national payer could use to improve member wellness, informing the launch of multiple consumer-facing services
- Advised a national payer on ways to assess the impact of potential wellness initiatives on presenteeism and absenteeism
Representative provider engagements
- Assessed the pricing and product offerings of vendors that could be enlisted as part of a broader healthcare service model
- Designed a study to evaluate the clinical and financial impact of a disease management program offered by an integrated services and devices provider
- Performed due diligence on potential merger partners for a financially struggling health system
- Advised a large investor on vendors providing clinical decision support systems
- Performed due diligence on a health services supplier to assess whether profit was derived from legitimate activities
Performance Improvement
We help clients identify operational, financial, and clinical levers that can improve performance and strengthen execution.
Representative payer engagements
- Helped a regional payer develop a retail strategy for the individual and small-group markets, ending a three-year trend of declining enrollment
Representative provider engagements
- Evaluated the financial impact of moving physicians affiliated with an academic medical center from volume-based payment to value-based payment
- Advised a health system on formulary strategy so that it could offer a more competitive proprietary health plan
- Devised a methodology for predicting patient-reported outcomes, enabling providers to assess performance more rapidly
- Enabled an urban trauma center to identify underbilling, resulting in the identification of 2% in additional revenue
- Analyzed the impact of physician fatigue on a rural critical care center’s revenue, identifying more than $600,000 in potential additional revenue
- Improved patient safety at multiple hospitals by measuring, analyzing, and strengthening safety culture
- Enhanced quality of care and improved workflow at a large academic medical center by developing a mobile application that enabled care teams to track patient care through a shared dashboard at the point of care
What These Engagements Have in Common
Analytical rigor
We bring economics, operations, healthcare policy, and quantitative analysis to questions that are too important for vague answers.
Decision relevance
Our work is designed to support actual decisions about growth, partnerships, operations, and investment rather than merely describe a problem.
Cross-sector perspective
Because we work across both payer and provider settings, we can assess issues that sit at the boundary between financing, delivery, and operations.
Looking for analogous experience?
These examples are representative, not exhaustive. If your organization is facing a related strategic or operational question, we would be glad to discuss it.