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Should Providers Start a Health Insurance Plan?

The authors chronicle four waves over the last century where health care providers developed health insurance plans. In the current wave, they name providers that have recently started plans as well as others that have opted to divest from their plans. The following patterns about provider-sponsored plans are noted:

  • About 1 in 8 hospitals operated a health plan in 2011, according to American Hospital Association data.
  • Most of these plans are operated by not-for-profit health systems and by non-academic systems.
  • Most plans have not expanded beyond the provider’s geographic service area.

The pros and cons for provider-sponsorship of health plans are briefly identified. Finally, the five largest provider-sponsored health plans based on enrollment are identified, with the Kaiser Foundation Health Plan topping the list.

Source: Myers C and Fleming K. Should you enter the new wave of provider-sponsored health plan development? Strategic Financial Management, Aug. 22, 2013. http://www.hfma.org/Content.aspx?id=19176

Update – related source: Dunn L. Hospitals as health insurers: should your system launch an insurance product? Becker’s Hospital Review, Nov. 5, 2013. http://www.beckershospitalreview.com/racs-/-icd-9-/-icd-10/hospitals-as-health-insurers-should-your-system-launch-an-insurance-product.html

Update: Morrison I. Risky business: health systems become insurers. H&HN [Hospitals & Health Networks] Daily, May 6, 2014. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Daily/2014/May/050614-morrison-health-insurance

AHA Resource Center (312) 422-2050, rc@aha.org

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