Provider-sponsored health plans are expected to continue growing with 50 percent of health systems having either applied or intend to apply for an insurance license.
As health systems and physician groups prepare to launch their own plans, they must consider whether they have the necessary building blocks to successfully make the leap, how integrated a model they will pursue and whether they will use a build, buy or partner strategy, according to PwC.
First, providers should consider the foundational building blocksneeded to successfully execute a provider-sponsored health plan, including but not limited to prior experience, strong leadership, financial reserves and strong networks across the continuum of care.
Second, they should evaluate the level of integration need for the provider-sponsored health plan and whether it will be a network, profit center or integrated model.
Third, providers should explore the potential financial implications of integrating a health plan. Launching a health plan requires significant upfront investment with profit likely years away, according to PwC. Therefore, providers should carefully evaluate their potential return before launching a plan.
Lastly, providers should find ways to differentiate their health plan. Provider-sponsored health plans can stand out against the competition by delivering more innovative health plan products and value-based reimbursement models tailored toward their communities.
More articles on payer issues:
NC hospital, BCBS reach contract agreement
Integrated Health Partners, Molina Healthcare partner to expand coverage
UnitedHealth to exit Indiana ACA exchanges in 2017
