Though two years of a pandemic were tough for the healthcare system, the post-COVID landscape is presenting opportunities for payer innovations and growth, according to a July 19 analysis from management consulting firm McKinsey and Co.
The report also included analysis of trends that may affect provider profits moving forward.
Twelve key takeaways:
Payer profit pools:
- Pools are shifting heavily to government lines and led by Medicare Advantage growth
- As the economy recovers from COVID-19, shifts from Medicaid to commercial lines are expected to increase commercial enrollment by 1.5 percent.
- Pools are expected to rebound to $57.4 billion in 2025 from $40.1 billion in 2021.
- Potential for return to pre-pandemic profitability, with pools rising at a 9 percent compound annual growth rate.
Opportunities:
- Payers are creating healthcare services and technology companies to serve members and sell services to other organizations.
- Management services organizations are being created to actively manage patient care.
- Diversification is creating new value pools and creating value for existing business by lowering care costs through better analytics and improved coordination.
Value-based care:
- Value-based care models are looking to create better care costs, access, quality and experience.
- Medicare Advantage lines are evolving to facilitate ownership of physician practices and virtual, home and pharmacy providers.
- MA plans are also taking more control over care management, medication adherence and enablement services.
- Value-based care models are facilitating more data- and analytics-enabled clinician services, which may increase profit pools by two to three times.
- To increase value-based care, payers are looking to acquire, partner with private equity firms, or invest to become minority partners.