Gartner Information Technology Research

Industry Vision: Health Value Management, U.S. Healthcare Payers’ Next-Generation Transformation Strategy

Published: 27 March 2020

ID: G00466176

Analyst(s): Bryan Cole, Jeff Cribbs, Brad Holmes, Mandi Bishop

Summary

Healthcare payers must adopt a health value management business model to ensure a satisfying member experience. Healthcare payer CIOs must help by shifting their focus from claims adjudication to a new focus that delivers customer-defined value.

Table Of Contents

Analysis

  • CIOs Feel the Pressure of Payer Business Model Change
  • Health Value Management Is an Outside-In Strategy to Improve Payer Performance
  • The Business Capabilities of a Health Value Management Organization
    • Population Health Management
    • Consumer Engagement
    • Provider/Partner Alignment
    • Purchaser Alignment
    • Regulatory and Policymaker Alignment
    • Administration
    • Intelligence
  • Make the Health Value Management Vision a Reality

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