An Overview of Healthcare Payer Industry

Healthcare Payer Industry Primer

The US spends more on healthcare than any other country, with these healthcare services financed by a complex mixture of public and private payers. There is no single nationwide model of health insurance and insurance programs all differ with respect to benefits covered, sources of financing and payments to healthcare providers. As well as being the most expensive, the US healthcare system is the most complex.

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This primer will introduce you to the different types of insurance programs in the US, how they are financed, underwritten and administered. You will learn about the key characteristics of an insurance plan and how insurance companies work with health providers, the government, employers and other key players like Pharmacy Benefits Managers to deliver insurance coverage.

Course: 5 Chapters

Est. time: 45 mins

What's Covered In This Primer?

Introduction

Characteristics of an Insurance Plan

US Payers

Insurance Plan Contracts

The Reimbursement Process

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Chapter 1 Breakdown

What is the health insurance model in the US?

Chapter 2 Breakdown

What are the components of a healthcare coverage plan?

Chapter 3 Breakdown

Private payers
Public Payers - Medicare
Public Payers - Medicaid

Chapter 4 Breakdown

Insurance Companies & Financiers
Insurance Companies & Providers
Insurance Companies & PBMs

Chapter 5 Breakdown

What are the steps from a patient requesting a healthcare service to the payment of an insurance claim?

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Healthcare Payer Industry Trends

How Our Healthcare Payer Industry Primer Can Help

Build A Foundation

Go from newbie to knowledgeable in under an hour! Our primers break down the essentials of an entire industry - products, trends, terminology, and more - into a concise, easy-to-digest format. Gain the knowledge you need quickly, so you can hit the ground running with confidence and clarity.

Boost Your Credibility & Confidence

Stand out when it counts! Our primers are packed with industry insights, allowing you to navigate professional conversations with greater confidence and leave a lasting impression. With a solid foundation in industry knowledge, you'll feel prepared for any client conversation that comes your way.

Gain Competitive Edge

Nothing beats knowing! Our primers are concise but we never skimp on insights. Staying up-to-date on industry challenges, opportunities, and trends empowers business leaders to make informed strategic decisions and maintain a competitive edge.

Primed for Success

Trustworthy insights, sourced from subject matter experts

Organized and streamlined into digestible lessons

Presented in binge-worthy videos that learners love

Testimonials

This topic is very intriguing to me and often times very complicated. But the way this course was designed and delivered, it made it very easy to understand.

- Consultant

The videos were short enough to quickly complete and make progress. The animations and visualizations really helped to communicate the message, allowing me to understand the information really well.

- Management Consultant

The industry information was relevant, easy to understand and the course was just long enough to provide a baseline to address the payer vertical.

- SaaS Sales Professional

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Frequently Asked Questions

What is a primer?

Think of a primer as your quick-start guide to understanding the landscape of an industry (such as Investment Banking, Renewable Energy, Retail, etc.).

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Industry information is readily available but Googling can lead you down a rabbit hole of scattered, inconsistent and text-heavy resources - leaving a fragmented picture of the industry. And this content can miss the mark: they’re either too long and full of extraneous details, making it tough for beginners to find what they need, or too short, leaving out critical detail.

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Primerli is changing this! All our primers are presented in a concise, engaging format, covering everything you need to know in binge-worthy videos.

Who are the primers intended for?

Primers are perfect for anyone looking to understand an industry, fast. Whether you’re a consultant preparing for a case in telecom; a salesperson hoping to make headway with a big pharmaceutical customer, or a student preparing for their first job interview, primers are the prep step that enables success.

How long does it take to complete a primer?

A full primer takes less than an hour. We pack tons of insights into each primer collection of bite-sized, binge-worthy videos that you can watch anytime, anywhere. Perfect for busy schedules - because learning shouldn’t take forever.

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And for industry aficionados, our primers are split into sections so you can bypass the introductory info and stay up-to-date on trends or brush up on terminology in less than 10 minutes.

What topics does the primer cover?

Each industry primer covers the essentials: key trends, terminology, value chain, economics, and products & services. But some of our technology and functional topic primers include additional sections to make sure all the critical information is covered and each primer is comprehensive.

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