White Paper

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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May 3, 2016