Health plans are positioned to bring sustainable market reform, but they will need a new business model to do so. Half of the U.S. health benefit market is driven by employer funding. Most Americans (165 million) who do not rely on Medicare or Medicaid access the health system through an employer-funded or employer-sponsored product.
However, over the past decade, many employers reduced benefits or shifted costs to their employees and some completely cut benefits. In order to understand the landscape of possible options to address the current coverage and affordability crisis, Oliver Wyman undertook a year-long collaborative assessment. Working with leading healthcare organizations (health plans, information technology, and care management firms) and conducting proprietary research, Oliver Wyman designed a new business model designed to lower the cost of care, improve care quality, and maintain medical trend below 5% while improving consumer, employer, and provider satisfaction.
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