CASE STUDY

‘Groundbreaking’ Omni-Channel Strategy Helps Large Health Payer Better Engage with Members at Entry of Care

SERVICES

Innovation Strategy and New Venture Development

Program T ransformation & Management

Process Optimization

THE CHALLENGE

Entry-of-care strategy needed to improve patient experience and solidify market leadership

The client, a major U.S. healthcare payer, wanted to develop a “groundbreaking” strategy to better engage with members at the entry of care, with the goals of improving patient experience, curbing costs associated with delivery in the state market, improving access to care, supporting independent providers, growing its market share, and build upon its high-value brand status. Optimity was tasked with creating an industry-disruptive plan without any former proxy, to help the payer ultimately become “the state health plan.”

To enter into the direct delivery of care involved developing an innovative, market-differentiating, consumer-centered, cost-effective and high-quality approach to primary care, as well as a phased implementation strategy and plan (including required capital investment, financial pro forma, phases, locations and resources).

In the strategic development plan, Optimity defined the Minimum Viable Product (MVP), business model, implementation, and costs associated with iterative product development and core business functions for the new innovative product.

OUR SOLUTION

Create market-differentiating, high-quality care delivery product

Optimity researched and analyzed optimal opportunities for market entry and product development, provided the client with a strategic product development roadmap, and provided the client with business development materials to create leverage among future payer and provider partners.

To refine the client’s market entry strategy, Optimity aligned various stakeholders, capabilities and technologies necessary for the delivery of care. Then Optimity identified the limitations of the current healthcare delivery system. To identify optimal opportunities to satisfy these gaps, Optimity researched state and national health demographic data, internal client data, competitive analysis data, and consumer input data. Once identified, Optimity guided project implementation with a comprehensive agile GANTT chart. In addition to strategy development, Optimity outlined a 10-year financial and human capital investment plan for the client.

In the strategic development plan, Optimity defined the Minimum Viable Product (MVP), business model, implementation, and costs associated with iterative product development and core business functions for the new innovative product. This included research and analysis on capital investment, financial pro forma, phases, locations, resources, and other important aspects of holistic product development.

Optimity developed innovative “health center hubs” across the client’s state. This new holistic care delivery model connects consumer needs across clinical, social, and cultural care entities via lifestyle extensions. To ensure behavioral change, Optimity provided an integrative IT development plan across various interfaces.

Finally, to secure the sales potential of this innovative product, Optimity performed a comparative analysis of potential payer and provider partners, including other supplemental business development material to demonstrate return-on-investment (ROI) and the likelihood of success.