Thriving in a regulated era: Guiding new value creation

With several of the Affordable Care Act (ACA) provisions already implemented, the marketplace presents several opportunities for growth. Your organization may be considering expansion into new geographies, establishing new offerings in government health plans or competing in the individual marketplace.

In this first post of our blog series on thriving in a regulated era, we’ll review some of the key considerations that can help you grow, adapt and thrive in this dynamic time.

The definition of success has changed.
Standardized benefit offerings and network contracts are no longer the path to success. A one-size-fits-all-approach doesn’t work for today’s consumers, who demand higher consumer engagement, greater transparency and flexible benefit design.

The market’s transition to fee-for-value means a transfer of risk — payers and providers must collaborate to create higher quality care at lower cost.

Engineer your business vision.
Capitalizing on growth opportunities begins with identifying market demands and your business vision:

  • What market do you want to target?
  • How feasible is your success within that market?
  • What are your key market development drivers?
    • Speed to market
    • Quality excellence
    • Risk tolerance
    • Organizational control

Speed, quality, risk and control are four independent variables that must be regulated to determine market feasibility and keys to success. Defining your business vision will help you determine how to address these four aspects.

Establish your business model.
A business model — one that specifically tells you what it will take to build your vision — can help you determine how to implement your business vision. Surprisingly, this is a consideration many organizations bypass. Your business model must define your business objectives, strategies, financial goals and success measurements.

When entering new markets or starting up a new plan, the implementation methodology of your business model will need to align your complex health system with market needs, regulations, emerging technologies and organizational capabilities. This is where a feasibility study comes into play — it’s the first step in assessing your new business venture.

Develop your business plan.
Your business plan is essential to laying out your road map and organizational model. It defines your strategy, which will provide clarity and a framework for executing your vision. It helps you not only see the long-term vision, but also plan for short-term business results. Keep your business plan flexible enough so it adapts to your business growth and changes in industry demand.
Next week we’ll continue our review of considerations that can help you achieve your go-to-market vision. An in-depth review of all these considerations is available in our white paper, “Thriving in a regulated era: Key considerations to guide new value creation.”


About the Author:

Jim MahJim Maher headshoter

Vice President, Optum, Optum Consulting Group
As part of the operations and administration consulting practice at Optum, Jim Maher is responsible for client advisory services. With 25 years of consulting experience, Jim’s core competencies include legacy transformation, business process reengineering, IT solution development and implementation, migration planning and complex program management.

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