Eureko, a large insurance group operating in the Netherlands under the Achmea brand, faced a tough decision in 2006. The Dutch government had implemented radical market reforms that fused a partly public, partly voluntary and private system into one mandatory national health insurance program executed by private insurers. Amid uncertainty about future cost and premium levels, many stock-listed companies opted to leave the health insurance business.

Achmea, which had grown during two centuries of mergers between mutual insurers, faced a choice of either exiting health insurance or going into it big and competing on quality to win substantial market share. “We decided on the latter because we were good on the commercial side,” explains Jeroen van Breda Vriesman, Eureko’s executive board member responsible for the health division and for group information management and technology. “So we went in, although we knew we would be losing a lot of money in the first year.” The company launched a “lean” transformation of its health division, which went from a loss to profitability in three years, and then started to scale up that transformation across Achmea’s nonlife, life insurance, pensions, and other activities in 2008.