Payers
New strategies and solutions for a transforming market
Payers need to prepare themselves to operate in a new market. Regardless of the direction that the regulatory winds blow, you will face relentless operational and strategic challenges to stay competitive. You must develop strategies to decelerate rising medical costs, maximize return on IT investment, simplify administrative practices, transition from ICD-9 to ICD-10 and focus on product innovation and grow market share. Evolve your medical management program along the continuum of health and work collaboratively with employers, members and providers for mutual benefit.
Industry-leading experience and expertise
To accomplish these challenging tasks in these turbulent times, you need experienced professionals. Thought leadership from a firm with deep health-industry knowledge. Broad business expertise in advisory, tax and assurance services. PwC's health-industry professionals align their understanding of payers' core business processes to the firm's financial management and tax expertise, offering our clients a well-balanced and comprehensive combination of skills.
We know the challenges you face in today's marketplace
To overcome obstacles during these turbulent times, you need experienced professionals — thought leadership from a firm with deep health-industry knowledge. Explore these common challenges and learn how PwC is addressing them head on.
Our featured thinking
- Medicare ACOs and shared savings models
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Medicare ACOs and shared savings models
This brief provides a financial analysis of the ACO opportunity, including a breakdown of ROI and cash flow possibilities.
- Top health industry issues of 2012
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Top health industry issues of 2012
This year's report provides more insight into the following trends: the impact of higher deductibles, how providers and insurers are teaming up for population health, potential drug shortages, health informatics, privacy and security, health insurance exchanges, pharma industry adapts to a post-blockbuster business model, social media in health, how politics may influence policy.
- Old data learns new tricks: Managing patient security and privacy on a new data-sharing playground
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Old data learns new tricks: Managing patient security and privacy on a new data-sharing playground
Data is quickly becoming one of the health industry's most treasured commodities. Yet, health organizations are acutely aware that sensitive data can be easily compromised. In just the last year and a half, a breach of personal health information occurred, on average, every other day.
- Quick thinking: Four key findings from health reform
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Quick thinking: Four key findings from health reform
A condensed version of PwC's reports, providing the industry with some "quick thinking" about how health reform will change the business of healthcare. The brief explores four key findings around health IT, physician-hospital alignment, mobile health, and the health insurance exchanges.
- Breakthroughs: The high-performing surgical program
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Breakthroughs: The high-performing surgical program
Leaders must find new ways of approaching surgical care and strategy, from creating a true surgical team built around the patient, focused on quality, safety, and the most current best practices, to a shared responsibility for the appropriate use of technology.
- Change the channel: Health insurance exchanges expand choice and competition
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Change the channel: Health insurance exchanges expand choice and competition
Starting in 2014, insurers will compete head to head as health insurance exchanges open up consumer choice and a new $60 billion market.
- The new gold rush: Prospectors are hoping to mine opportunities from the health industry
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The new gold rush: Prospectors are hoping to mine opportunities from the health industry
PwC surveyed US consumers and found they would be willing to spend more than $13 billion a year of their own money on new services. It's the promise of those new products and services that is enticing more and more businesses to turn to the US health system as an opportunity for innovation, differentiation, and profits.
- Behind the numbers: Medical cost trends for 2012
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Behind the numbers: Medical cost trends for 2012
This year's report indicates that the medical cost trend is expected to increase from 8% in 2011 to 8.5% in 2012. An interesting blend of reactions to the recession, the slow recovery, health reform, and other variables are factored into the medical cost trend in 2012.
- Stalking the ACO Unicorn
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Stalking the ACO Unicorn
PwC has released a brief to address the implications of the proposed regulations for Accountable Care Organizations (ACOs). Included are key findings from the proposed Medicare regulations, an implementation timeline for the ACO program and frequently asked questions with corresponding answers.
