WHAT WE DO HOW OLIVER WYMAN S HEALTH & LIFE SCIENCES TEAM DRIVES INNOVATION BY IMPLEMENTING TRANSFORMATIVE IDEAS. Oliver Wyman

Transcription

1 WHAT WE DO HOW OLIVER WYMAN S HEALTH & LIFE SCIENCES TEAM DRIVES INNOVATION BY IMPLEMENTING TRANSFORMATIVE IDEAS

2 Population Health Management Oliver Wyman helped a large national retail pharmacy chain design and implement an innovative population health management program Client situation Oliver Wyman approach A large national retail pharmacy chain was facing increased competitive pressures from within the industry, including margin compression, increased use of generics, and slowing small molecule innovation Moreover, in a healthcare industry shifting definitively to fee-for-value, the client would have to move quickly or lose out to competitors already making the transition Thus, the client engaged Oliver Wyman to help develop and implement a population health management solution to both position the company as a leader in valuebased care and combat pressures in the retail pharmacy industry Initially, Oliver Wyman worked to design the key elements of the client s population health management program, including identifying the target population, developing a service offering, and quantifying monetization opportunities Following the initial strategy phase, Oliver Wyman worked with the client to implement a pilot version of the program and subsequently roll the program out to multiple markets nationwide 1

3 Population Health Management Oliver Wyman helped a large national retail pharmacy chain design and implement an innovative population health management program Key impacts achieved Designed an innovative population health management model repositioning the client s existing assets in value-based roles to drive improved outcomes and reduced costs for patients and physicians Successfully deployed a pilot version of the program High stakeholder satisfaction (patients, physicians, pharmacists, etc.) Highly encouraging preliminary outcomes readouts (e.g. substantial weight loss, high medication compliance) Identified a suite of monetization opportunities ranging from short-term, front- and back-ofstore plays to long term, risk-based contracting opportunities Created an accompanying economic model to aid the client in evaluating the economics of these opportunities at the provider, or deal, level and tracking the program s overall economic performance Developed a robust provider pipeline and generated significant interest in the program among those providers, resulting in partnerships with several large, reputable provider groups, with more to come 2

4 Telehealth Company Portfolio Analysis Oliver Wyman assessed opportunities for expansion in the health and wellness industry for a telehealth provider focused on urgent care Client situation Oliver Wyman approach A leading privately-held US telehealth provider that provides urgent care services was a maturing start-up business that wanted to understand the opportunities available for expansion and growth Client wanted to leverage its core capabilities and be well positioned for growth Project aimed to size and assess the opportunity in the health and wellness space Developed a framework to look at opportunities in spaces adjacent to telehealth urgent care Assessed opportunities in the wellness, urgent care, behavioral health, dermatology, second opinion, and disease management spaces by: Defining each space Assessing competitiveness of the space Sizing the relative opportunity of each space We also provided considerations for portfolio development and strategic growth 3

5 Telehealth Company Portfolio Analysis Oliver Wyman assessed opportunities for expansion in the health and wellness industry for a telehealth provider focused on urgent care Key impacts achieved Client was able to better understand the opportunities in the mobile health and telehealth space Client leveraged key findings to make an investment decision with its leadership team 4

6 Evidence-Based Practice for Disease Management Oliver Wyman assisted a policy body in understanding potential for individual and community support in prevention of certain diseases Client situation Oliver Wyman approach While non-communicable diseases (NCDs) are a growing concern both globally and in Malaysia, community and individual empowerment have been proven to decrease prevalence and risk factors The client requested a limited review of the academic literature on individual and community empowerment for the management of NCDs, and subsequent facilitation of a one-day workshop in Malaysia We adopted a seven-step framework to anchor findings from our limited literature review on best practices Findings were then set as the basis for stakeholder discussion and engagement Stakeholder feedback and scientific evidence will be later used to formulate a strategic roadmap and codification guide for Malaysia to develop a feasible, culturally relevant, and replicable individual and community empowerment plan 5

7 Evidence-Based Practice for Disease Management Oliver Wyman assisted a policy body in understanding potential for individual and community support in prevention of certain diseases Key impacts achieved The strategic roadmap and codification manual developed will help the client implement better evidencebased and culturally relevant programmes to prevent and control NCDs The reach and impact of these programmes will potentially have a multiplier effect on NCD management even across geographically inaccessible areas in Malaysia Roadmap for Individual and Community Empowerment in NCD Management We propose a 7 step framework by which to support efforts to empower individuals and communities in Malaysia 7 End-in-mind: To formulate a strategy roadmap and codification guide for Malaysia to develop a feasible, culturally relevant and replicable individual and community empowerment plan Conduct Facilitate Discuss the limited workshop implications literature with key for Malaysia review stakeholders 3 Understand the broad concept of individual and community empowerment respectively 1 2 Introduction to NCDs Set the context Why the workshop? Focus of Pre-Read 5 NCD Prevention and Population Health Individual and community empowerment can help the population achieve positive health outcomes against NCDs Improved well being and health-related quality of life Greater health equity NCDs Reduction of risk factors Better management of NCDs NCDs Positive behavioural outcomes NCDs Socioeconomic Environment Access to Effective Health/Social Care Lifestyle/Health Behaviour Gender Socioeconomic Group Ethnicity Sexuality Age Disability Geography Individual Empowerment Community Empowerment Strengthen community action Develop personal skills Build healthy public policies Create supportive environments Reorient health services Across the lifespan Across different settings Individual Family School Work Community Source: SIN-FSP

8 Implications of Private Exchanges Oliver Wyman partnered with a biotech company to identify key impacts and potential responses to the adoption of private exchanges Client situation Oliver Wyman approach Recent employer adoption of private exchanges threatens to dramatically change the landscape of employersponsored benefits The client is engaged with employer coalitions but has no existing relationships with private exchanges The client needed to understand the magnitude of private exchange adoption and key implications for its business Our client s team was tasked with creating a perspective on the importance of private exchanges and resulting recommendations for action Conducted 15+ interviews with key stakeholders across the industry to understand up-to-date perspectives on impact Led small-group meetings with internal stakeholders to understand and centralize relevant knowledge of account managers and others with field interactions Segmented private exchanges by business model, revenue drivers, and associated potential opportunity and risk Created an action plan outlining next steps and assigning organizational owners to drive progress 7

9 Implications of Private Exchanges Oliver Wyman partnered with a biotech company to identify key impacts and potential responses to the adoption of private exchanges Key impacts achieved Synthesized private exchange trends into three key implications Developed recommendations for action based on trends Created a business case and suggested action plan for outreach to private exchanges 8

10 First-Mover Path to Population Health Oliver Wyman charted first-mover path to population health with potential to up the operating margin 4 to 5 percentage points Client situation Oliver Wyman approach Client sought to become a population health manager with first-mover advantage, while enhancing its core fee-for-service business Market competitor stated similar desire to shift to value; strong threat from independent population health manager in market Oliver Wyman was brought in to design the value transformation, with a focus on the payer strategy, and to serve as the client s interim COO for its Clinical Integration organization Created an integrated and robust financial model to manage and maintain financial strength of organization throughout clinical transformation and fee-for-service to feefor-value transition to risk Developed detailed plan for payer partnership in Medicare Advantage, employee, employer, and exchange products Determined path to close capability gaps and assessed potential vendors on population health management capabilities Redesigned inpatient care coordination and programs for employee health as no regrets moves 9

11 First-Mover Path to Population Health Oliver Wyman charted first-mover path to population health with potential to up the operating margin 4 to 5 percentage points Key impacts achieved Launched a Clinically Integrated Network with more than 1,200 physicians Accepted into Medicare Shared Savings Program and secured shared savings contracts with several payers Achieved significant enrollment in narrow-network exchange product Over five years, the transformation plan underway has the potential to increase the organizational operating margin by 4 5 percentage points 10

12 Commercialization & Clinical Transformation Oliver Wyman developed transformation strategies to grow long-term fee-for-value business and bolster short-term fee-for-service business Client situation Oliver Wyman approach Leadership recognized the market shift to value and wanted to position the organization for value based care in the long-term while bolstering its fee-for-service business in the short term Over the last 2 3 years, Oliver Wyman has supported both corporate and local market strategies with value-based efforts focused on commercialization and clinical transformation and on near-term growth strategies focused on maximizing production from assets spanning acute, post-acute, and ambulatory sites of care Developed an analytical framework to quantify pace and size of value-based opportunity across markets and then aligned the national value transformation strategy Designed value-based commercialization playbooks for local markets, outlining key contracting and clinical model requirements, milestones, and resource needs Diagnosed and implemented crosscontinuum care coordination and care management strategies to support client s Accountable Care Organizations (ACOs) Created a corporate ambulatory post-acute care investment strategy 11

13 Commercialization & Clinical Transformation Oliver Wyman developed transformation strategies to grow long-term fee-for-value business and bolster short-term fee-for-service business Key impacts achieved Engaged in risk-based contracting with key payer partners in all major markets and helped establish 5 Medicare ACOs via the Medicare Shared Savings Program Equipped national care management leadership with comprehensive implementation plans to deploy extensivist care models across markets Identified and implemented scalable care coordination and care management process improvements to improve patient outcomes while reducing annual costs by ~$10MM for a single local system 12

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