Case study

Health services leader targets large reductions

A health services leader targeted 25%–35% reductions in claims, commissions and provider/member services as it geared for reform.

^{_{Industry: Healthcare

Services: Consulting

Country: South Africa}}

Situation

The client (a national health plan) recognised a need to position itself in a rapidly evolving business environment. In response, they wished to reduce administrative cost and develop a low-cost model. Their scope included all functions across the front, middle and back office. The business segments that were considered in scope were individual and small-group, up to 100 lives. The client decided to adopt a lower cost structure in these segments by 2013–2014 to address a permanent industry shift.

Key issues

Client already used shared services for most functions, complicating the development of a financial baseline and identifying saving opportunities specific to the impacted business segments.
Market and regulatory forces pressured the client to become nimble and efficient in small-group, individual segments.
Client wanted assistance to
- Identify, analyse and quantify potential savings opportunities;
- Create plans, required investments and timelines to capture the savings opportunities;
- Develop communication plans for the regional leads; and
- Install a change and programme management function to oversee implementation.

Stragety& contribution

Identified and developed a comprehensive set of hypotheses for potential
savings opportunities.
Analysed financials across the company and performed a benchmark analysis to understand areas of potential opportunity.
Interviewed senior leadership team, function leads and other relevant team members across the organisation to test the hypotheses.
Analysed potential opportunities, quantified benefits and implementation costs.
Prioritised opportunities, and developed a cogent set of recommendations and an accompanying high-level implementation plan.
Launched and guided a detail design for the identified savings opportunities focused on the specific functions (product optimisation, sales and distribution, quoting and rating, case installation, member enrolment, billing).