What Works: Medical cost management

The changes brought about by the Affordable Care Act (ACA) have placed greater financial risk on health plans than ever before, while simultaneously decreasing margins. As the effects of new legislation are realized and health plans acquire more Medicare, Medicaid and exchange members, the importance of insurer-side medical management is further compounded.

There is hope, however.

Through the systematic and strategic use of data and analytics, health plans can develop more targeted and efficient medical management operations, thus increasing the return on investment while continuing down the path toward value-based healthcare.

This white paper is a result of KPMG’s experience, as well as a survey and interviews conducted with 24 Medical Directors and/or care management leaders from health plans across the United States.