Every health plan must choose how to win the battle for membership and competitive advantage while reducing operational costs. To make this decision, the health plan’s business goals play a critical role in determining how to spend budgets effectively.
For example, a health plan with majority market share may decide to focus on retaining members through outstanding member and provider service. A health plan that is trying to enter a new region may choose to focus on winning new employer contracts and direct pay customers by providing low cost, consumer directed plans. A health plan with aspirations of playing in the national arena may choose to focus on building stronger relationships with providers and proving its value in clinical care.
In each case, a decision on strategic goals leads directly to how health plans should spend resources improving how it interacts with constituents. The high-level vision then cascades down to all lower-level decisions. Health plans must execute on each of these critical underlying tactics to achieve success and drive their strategic course.
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