Payor consumerization

The rise of consumerism in the health insurance sector is already underway. Large groups are shifting coverage decisions and management to their members, and insurance exchanges are stimulating growth in the retail segment of the market. A new surge of individual insurance buyers will force ever greater attention on the needs of members as opposed to employers.

In the coming years, as the basis for the health insurance sector is transformed, leading payors will pursue consumerization by shifting their focus from business as usual to the development of new business models, capabilities, and offerings that will rival sophisticated consumer product companies, such as Apple and Proctor & Gamble.

PwC’s Strategy& works with payors in the design and execution of consumer-centric strategies to not only win share in the fast-growing retail markets, but also support the cost reduction and outcome improvement necessary for a vibrant, sustainable healthcare industry. We recognize the difficulty of undertaking such fundamentally transformative and cross-functional change. Our teams have the deep experience and expertise in every key aspect of the insurance value chain and care delivery spectrum, the development of consumer capabilities, and the planning and implementation of large-scale change management that is needed to successfully achieve it.


Our thought leadership

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There’s a new boss in U.S. healthcare: the consumer. That’s the key finding in an extensive survey of 2,339 U.S. residents by Strategy&. The healthcare market as we know it is being upended, and the consumer is in the driver’s seat.
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The days of the disengaged health consumer are numbered. Consumerization will transform healthcare systems, involving individuals as never before in the management of their own care.
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Health insurance in the U.S. is at the cusp of a major transition from an employer-driven payor model to a model directly involving many more employees and consumers.
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The Supreme Court’s decision to uphold the Affordable Care Act (ACA) means that the transformational changes already underway in the healthcare system will accelerate in three key areas.
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As the pressures created by healthcare reform, consumer demands, and rising competition squeeze margins, health plans should consider a low-cost strategy (LCS).

Client example

Health plan product and portfolio strategy for public health exchanges
Facing strong regulatory pressures, one of the nation’s largest managed healthcare companies wanted to position itself for the changing healthcare landscape by shifting to a consumer-centric product strategy.

How we help our clients

Strategy& offers a comprehensive and integrated suite of services designed to support payor consumerization:

End-to-end transformations help payors design and implement consumer-centric strategies, operating models, and capabilities, including current state assessment, strategy formulation, and prioritized implementation plans.
Consumer-driven care delivery and engagement services support payors as they seek to surface behavioral insights and leverage them to craft member interactions and interventions that can help members better manage their own care and improve cost and care outcomes.
Consumer-centric operating model and customer experience services assist payors as they design operating models and tailor end-to-end experiences that enable the identification and enhancement of consumer touch points at every point, starting with the path to purchase and extending throughout the member relationship.
Consumer-driven product innovation services provide a detailed understanding of member-level market demographics, customer segmentation, lifetime customer valuation, purchase drivers, and price sensitivities. These services yield the deep consumer insights needed to produce compelling offerings that can attract and retain target members, and aid in the development of the consumer capabilities essential to building more profitable portfolios over time.