I am trying to solve a market entry case but the answer framework makes me confuse

Question

Here is my case:

Our client is Liberty HealthCare, a large health insurance firm based in the United States. Liberty HealthCare sells health insurance policies to businesses, which in turn provide health insurance to employees. While a large and reputable firm, our client has had stagnant revenue over the past five years and is considering entering a new market – the individual health insurance market.

When an individual purchases a health insurance plan on the individual health insurance market, they pay a monthly fee to the insurance company – which is called a premium – and in turn, the health insurance company reimburses the individual for incurred medical costs.

In the individual health insurance market in the United States, plans are sold directly to consumers, and Liberty Healthcare must sell different plans for each state. For example, the healthcare plans sold in California cannot be purchased by Americans living in Texas. Liberty Healthcare must comply with two additional major government regulations:

First, individual insurance plans must be available to all customers, regardless of health status, and all customers pay the same price – whether healthy or terminally ill – this is the guaranteed issue requirement.

Second, the American government provides money to individuals making below a certain income so they can afford their insurance in the form of government subsidies.

The CEO has hired your team to advise the client on whether or not to enter the individual health insurance market.

What are the factors you would look at when advising your client on this decision?

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=> My approach: I define this problem as to evaluate the attractiveness of the individual insurance market => then I use Porter 5 forces to analyze the case.

However, when checking the correct answer, they just look at 4 factors: the client's goal, how the client acquires customer, revenue opportunities and cost of providing this insurance.

My question is: is this answer from the case owner correct? If yes, how they can come up with these factors? What is the logic behind these factors?

Answer 1

Whilst there is certainly nothing wrong in applying the factors from Porter's 5 to this case, like the other commentators have said, I would highly discourage force-fitting a framework to any case and that too stating you will be using this framework in the interview.

WHAT IS THE ASK?

Try to think through as a very basic level, what the question is asking?

It is clear the company is looking for a new growth opportunity. In addition, "reimbursement" and "incurred medical costs" are mentioned, so it would seem important to think about profitability (and not just the "premium")

STRUCTURING THE CASE

Given you know it is a profitability question, you know the component parts are:

Revenue - i.e. Premiums Paid
Costs i.e. Incurred Medical Costs + Operating Expenses

For each of these you can break them down to get the data from the interviewer in order to make a recommendation, like below:

Premiums Paid = # Customers * $ Avg. Annual Premium Paid
- # Customers = $ Market Size * % Assumed Market Share in Y1 (you'll want to make an assumption of what is reasonable here e.g. <10%)
- $ Avg. Premium Paid = Single Price (guaranteed issue requirement)
Costs = $ Medical Costs + $ OPEX
- $ Medical Costs = % Claim Ratio in Y1 * $ Avg. value of claim
  - Both of these should factor the government regulation of guaranteed issue requirement
  - e.g. You can make an assumption of the distribution of customers by health status
- $ OPEX = % of revenue (make an assumption for this)
  - e.g. "I assume an average operating cost base for a services business of 20-40%"

EXTRA POINTS

To stand out even further, you can take the opportunity to demonstrate your business acumen by talking about "capabilities", and how easy/straightforward it will be for Liberty to enter the new market. This is a very important question when it comes to speaking to clients about a market entry strategy for real, and was a dedicated workstream on every market entry case I led.

Questions you can raise or mention you would like to think more about:

How close is the new market to the existing market in which they operate?
Does the company have most of the capabilities (people, processes, technology, licenses, culture) to easily enter the market as-is?
If there is a large capability gap, will the company need to buy/build to fill the gap?
Will this affect the likelihood of success at all?

Answer 2

Hello,

The answer is correct.

If you look at the case the client problem are stagnating revenues, which means your target is to increase them.

Decomposing now the target into its key components:

Additional revenue = # new insurance subscriber * # insurance fee

You could now work on these two components asking the interviewer for additional information/ making your own assumptions

Once you are done with that you should recall that typically companies are more interested in profits rather than revenues (See my comment on the end of this post on this). For this reason, you should consider the costs associated with the market entry.

Insurance usually adopt two metrics to describe costs:

- Claim Ratio: medical expenses as a percentage of insurance fee

- Admin Ratio: admin expenses as percentage of insurance fee

- Combined Ratio: Claim Ratio + Admin Ratio

Profits = Revenue * (1 + Combined Ratio)

Your interviewer could provide you this metrics if available in the case, otherwise you may need to come out with that with other information provided in the case. (e.g. average sickness frequency, average cure cost, cost of the new distribution channels, etc...)

Note on profitability: in specific occasions a company may be more interested in having fast growing revenues rather than profits, to the point of accepting negative profits for a limited time. This may happen in business requiring a critical mass to be profitable (insurance is one of these).

Don't hesitate to get in touch with me in case you need any further clarification,

Thanks,

Ale

Answer 3

Hello!

I overall agree with your approch.

However, I would totally disencourage you from ussing frameworks such as the "5 Ps of Porter" -they are too seen, and too shallow, to give a good impression in a real interview.

At this point, it´s just easier to apply common sense. Without further explanation, this seems as a profitbility case, in which we will analyze reveues, costs, and other factors that can influence this equalition (e.g., risks, social and political factors, opportunity costs, legislation, etc.)

Hence, you can start with a simple issue tree with:

Revenues: simple P x Q = new services * average price of them
Costs associated
Other factors that influence this equalition = risks, social and political factors, opportunity costs, legislation... there are plenty of them.

HOpe it helps!

Cheers,

Clara