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Provider-Sponsored Health Plans: Executive Perspectives

 In this economic environment all health plans carry risks. CLICK HERE to learn more how BHM services provide the tools for success while your organization focuses more on patient/member experiences.

Provider-Sponsored Health PlansTo better understand the opportunities with Provider-Sponsored Health Plans (PSP) and their approaches, experiences, and potential concerns, Deloitte convened nine executives from health systems, health plans, PSPs, and other organizations to discuss what it might take to develop successful PSPs. In the published report from that meeting comes the good, bad, and ugly of PSPs. Here are some of their perspectives.

Executives agreed that more health systems are now more interested in developing PSPs than in the past, and also concurred that:

  • Collaborative models are attractive to both parties.
  • Scale is important to be successful.
  • Required health plan capabilities and competencies are usually not found inside a typical health system.
  • Focus and leadership are required to align the hospital and health plan businesses.

Provider-Sponsored Health Plans Success

Common attributes of successful PSPs include:

  • Leveraging health plan and health system collaboration;
  • Aligning physicians through financial incentives and information-sharing;
  • Taking advantage of local market opportunities to increase share;
  • Participating in multiple lines of businesses, including Medicaid;
  • Focusing on population health; and
  • Prioritizing customer service.

Executives identified the following capabilities as most important for provider-sponsored health plans:

  • Actuarial skills for assessing risk, developing contracts, and modeling performance;
  • Claims, payments, and supporting technology for accurate and timely processes;
  • Patient engagement/customer service tools such as monitoring and call centers/schedulers; and
  • Analytics tools and skills to identify high-risk, high-cost and other important populations, as well as cost and quality performance trends.

Fortunately, today’s successful PSPs show that challenges can be overcome. Executives who built their small PSPs into market innovators and success stories shared their suggestions:

  • Start small but focus on gaining scale.
  • Experiment in the market with various lines of business, including your own employees and their families.
  • Determine whether to focus on Medicare and/or Medicaid.
  • Create specific strategies for your own market—it is not “one size fits all” because of regional competition and population variations.
  • Align incentives for both the health plan and hospital sides of the business and work collaboratively with the health plan leaders and clinicians.
  • Prepare for major capital investments.
  • Develop analytics-based operational capabilities.
  • Seek partners with a similar culture, vision, and market position.
  • Buy, rent, or collaborate for capabilities while gaining scale.
  • Share performance information frequently and be transparent in decision making.

 In this economic environment all health plans carry risks. CLICK HERE to learn more how BHM services provide the tools for success while your organization focuses more on patient/member experiences.

2017-07-26T16:57:45+00:00 By |Health Care Reform|

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