Asia Health Ecosystem Series, Volume II

New models, better value

This three-part series is a continuation of our Asia Health Ecosystems perspectives. Volume I explored key partnerships taking place across the value chain and how businesses can plan, design, and prepare for healthcare of the future. Volume II looks at refreshed roles for primary care and third-party administrators as the entire health system prepares for a more value-based world. This volume was jointly developed by Oliver Wyman and Sheares Healthcare

Healthcare’s traditional “truths” are changing. With no certain end to COVID-19, the world now recognizes that disease crises, when not actively managed or contained, can quickly spiral to bring entire health systems and economies to their knees. At the same time, Asia has a staggering “medical trend rate (defined as the increase in per capita medical claims costs due to medical inflation, utilization pattern changes, and other factors such as government regulations)" of 10.4%, outpacing the general inflation rate in Asia of 2.5%. The spike in both demand and unit costs means the need to improve value is not only necessary, but urgent.

Kitty Lee, Partner and Head of Health and Life Sciences in Asia Pacific, Oliver Wyman, commented, “As countries continue battling the rise of chronic disease, the world has now come to a painful realization: infectious disease epidemics are no longer ‘black swan’ events. Furthermore, the ‘double whammy,’ where a health system must actively manage both non-communicable diseases (NCDs) and infectious diseases, is no longer only applicable to emerging countries.”

“And yet, many of the challenges to developing a sustainable healthcare system are not new,” added Khoo Ee Ping, Chief Corporate Development Officer, Sheares Healthcare. “How do we optimize the utilization of scarce healthcare services and manage ballooning costs? How do we achieve better alignment of incentives between payors and providers? How do we treat patients holistically in a way that addresses both their medical conditions and their lifestyle choices? While these challenges have been exacerbated by the current crisis, there are reasons to be hopeful as new models of care are emerging with the right support from payors and regulators.”

This three-part series is a guide for health ecosystem stakeholders, investors, and consumers, offering a glimpse into the future of healthcare in Asia, as we envision it. This future is a world with refreshed constructs of care, with three foundation blocks: an amplification of primary care, greater payer-provider collaboration and coordination, and a joint march towards value.

In part 1, we explore the evolution of primary care as it shifts from today’s generalist model and amplifies into differentiated roles that will enable better value.

In part 2, we highlight the need for coordination and what the next generation of enablement looks like — differentiated functional capabilities and benefits from scale that support payers and/or providers in actively managing health. This shift requires both a focus and upgrade across capabilities such as utilization and claims management, network management, and data analytics.

In part 3, we suggest the ingredients for value-based care in this region and Asia’s journey towards value.

This report was also authored by T.K. Udairam, Chief Operating Officer, Sheares Healthcare and Khoo Ee Ping, Chief Corporate Development Officer, Sheares Healthcare.