Provider-owned health plans have been gaining momentum since the roll out of the Affordable Care Act and the impending shift from fee-for-service to value-based payment models. For providers hoping to get a handle on healthcare costs and supplement their own medical data with claims data, launching a health plan has been a strategic move.

In 2014, 15.3 million people had health coverage through a provider owned health plan and this number is expected to grow substantially by 2017 (cite Modern Health). But the amount of Provider-owned health plans is still relativity small, coming in at a total of 270 provider-sponsored across the country².

The Data¹

  • 1 in 5 health systems/providers to become health plan in 2017
  • 21% health systems plan to launch a health insurance plan by 2018
  • More than 1 million people in Pennsylvania, Michigan, New York and Texas are enrolled in provider-owned plan
  • 1/3 of the Wisconsin health insurance market is controlled by provider-owned plans

Key To Success: Provider-Owned Health Plans

A recent report from the PwC Health Research Institute noted many providers were able to launch their own health plan due to 6 key success factors:

  1. Understanding their investment needs. Evaluating their systems and a conducting gap analysis before such a big change.
  2. Getting to know the market. Health systems and providers did market research to see if a health plan could be supported in their market.
  3. Having a clear plan and business model. Understanding WHY they want to start a health plan.
  4. Building off of current brand recognition and community presence.
  5. Knowing how to differentiate themselves from other products in the market.
  6. Keeping-up strong partnership with insurers and learning how to collaborate.

BHM has extensive expertise working with both payers and providers. This makes BHM ideal for transitions to Provider-Owned Health Plans and ACOs.