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Provider-Led Health Plans Are Still Rare, But a Growing Number On Insurance Marketplaces

Hospital-led plans able to offer competitive pricing on marketplaces

While some health care systems have jumped into the business of sponsoring their own health insurance plans, so called "provider-led" plans are still rare, according to a report by Kaiser Health News (KHN).

According to FierceHealthcare, in 2014 only 13 percent of health care systems in the U.S. offered their own insurance plans. Those plans covered only a fraction of insured Americans, with about 18 million members, representing only about 8 percent of the market. Most of the people covered by provider-led plans are in Medicaid managed care or Medicare Advantage plans.

Interestingly, there are an increasing number of provider-led plans being made available on the health insurance marketplaces created by the Patient Protection and Affordable Care Act, according to KHN. Since the marketplaces opened in 2014, the number of provider-led plans has grown from 64 to 72, according to McKinsey statistics. In 2016, 19 percent of the new carriers on the exchanges will be provider-led plans, the report said.

Those plans are being offered at competitive prices, John Holahan, from the Urban Institute's Health Policy Center, told KHN. In some cases, plans offered by health care systems are the lowest priced silver plans being offered in 2016 in regions within some states. For instance, New York's North Shore-LIJ Health System, Oregon's Providence Health and Services, and Inova Health System in Virginia are among the lowest-priced silver plans, according to an Urban Institute analysis that looked at plans in 21 states.

While those low prices are attractive to consumers, some analysts say health care systems that get into the insurance business face many challenges and it remains to be seen how many will succeed in the long-term. However, health care systems, such as the University of Pittsburgh Medical Center, the nation's second-largest integrated payer-provider network, has seen successes, including efforts to cut readmission rates.

As FierceHealthPayer previously reported, the line between payer and providers is increasingly blurring, with doctors and hospitals needing to know more about the insurance world to provide complete care.

Source: FierceHealthcare, November 12, 2015

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