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Commercial · Medicare · Medicaid · Specialty

Strategy for
Payers.

We work with payers serving Commercial, Medicare, and Medicaid populations on their hardest strategic questions. These have included questions relating to employer and member segmentation, provider vertical integration, provider risk-sharing, geographic expansion, network strategy, population health and member engagement, diversification, and innovation.

FEATURED insights

  • Biopharma , 
  • Payers , 
  • Institutional

Outcomes Based Arrangements in Biopharma

Today’s advanced therapies target devastating diseases with high unmet need. Given the urgent medical need (and pressure from patient advocates), regulators increasingly must make decisions based on early, incomplete data when it comes to durability, real-world effectiveness, and cost-effectiveness – all while bearing costs that can exceed $1 million per patient.

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Policymakers globally are grappling with how health systems should manage a combination of high upfront costs and uncertain long-term value.

— Recon analysis

Outcomes Based Arrangements in Biopharma

  • Biopharma , 
  • Payers , 
  • Institutional
Today’s advanced therapies target devastating diseases with high unmet need. Given the urgent medical need (and pressure from patient advocates), regulators increasingly must make decisions based on early, incomplete data when it comes to durability, real-world effectiveness, and cost-effectiveness – all while bearing costs that can exceed $1 million per patient.

Read more

AJMC: More frequent visits to primary care can save net $30-40 PMPM for top 20% highest risk commercial members

  • Payers , 
  • Providers
A new AJMC study from consulting firm Recon Strategy is the first to s…

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Kidney transplantation, improved but still a significant missed opportunity

  • Payers , 
  • Providers , 
  • Institutional
In order to make a more immediate and significant impact on dialysis and kidney waitlist, OPOs need to ensure that significantly more potential donors are identified, and all necessary steps are taken to ensure that a potential donor becomes an actual organ donor.

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featured CASE STUDIES

How we've helped our payer clients

Representative engagements, anonymized. Each pairs deep sector knowledge with rigorous, structured analysis.

  • Payers, Providers

Medicare Advantage channel strategy

A personal care platform faced a payer market that was growing fast but buying in two incompatible ways and needed to know which model to build its sales approach around.

Payer partnership economics

  • Payers

Payer employer segment growth strategy

A state-wide health plan was losing the mid-size employer market and needed to find the employer segments where it could develop a real edge and a strategy to convert into share.

Employer buyer segmentation and targeting

  • Medtech, Early Stage

Molecular diagnostics growth strategy

A molecular diagnostics developer had more new-test opportunities than it could fund and no shared view of which it was equipped to win or whether the economics could work.

New test portfolio prioritization

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