- For a Large Group Regional payer, identified a $25MM profit/price improvement opportunity, modifying the pricing model in the 50-500 Employer size market where a traditional combination of experience and manual rating was resulting in anti-selective member lapses and spiraling medical costs.
- Helped a Regional payer turnaround a $50MM+ Individual ACA market loss in one year. Developed a “full potential” list of strategic initiatives impacting product, formulary, direct to consumer marketing, network, channel and Risk Adjustment coding.
- Redesigned the full ACA product portfolio and Rx formulary for a not-for-profit Regional payer, based on a post Risk Adjustment view by segment. The overall CMS target AV was achieved by enriching the benefits utilized by Target segments and offsetting with others. The result was a favorable shift in the member mix, allowing for material price reduction and market share growth.
- Helped a Regional provider owned payer reduce price by 7-10% to profitably grow market share in the 2-50 Small Group space, by minimizing cross-subsidization of unprofitable areas and segments.
- Helped a Multi-State payer revise its channel and broker strategies to align investment with risk management, competitive presence, and growth of new business and retention in Target segments.
- Helped a regional Medicaid payer develop strategies to profitably grow market share, by identifying addressable segments of eligible uninsured where their provider network was most efficient.
- Helped a Regional Provider owned payer, build a CRM database, integrating internal membership, customer experience, profitability, sales, underwriting, quoting, agent and utilization data with competitive intelligence and external third-party demographic, behavioral and census data. This is now actively used in the prospecting, acquisition, retention and underwriting processes to improve close rates and remove bottlenecks in the sales waterfall particularly for target member segments.