Provider-led health plans: The future of healthcare reform?

As health reform continues to evolve, provider-sponsored health plans have emerged as one of the most effective ways to manage care and control costs, according to Paul Keckley, Ph.D., managing director for the Navigant Center for Healthcare Research and Policy Analysis.

In a recent blog post, Keckley explains that "Health Reform 2.0" will be all about cost containment, and perhaps the best way to achieve that goal is to marry healthcare financing and delivery. In fact, providers and payers have already begun to redefine their traditional roles, Keckley has written previously.

Such provider-sponsored plans "will compete against private insurers for members, but their purpose--total population health management in the communities they serve--will distinguish their ambition," he writes.

Yet the transition to integrated systems of health will hardly be easy. Private insurers argue that providers can't be trusted to manage costs and don't have the capabilities to run their own insurance plans, Keckley says.

But he points out there is a wealth of data available for employers and consumers to keep providers honest about cost control, and there's evidence that health systems can successfully integrate care financing and delivery. On such example is Kaiser Permanente, which has a payer-provider business model that's served it well since the Great Depression, Bernadette Loftus, M.D., associate executive director of the Permanente Medical Group, previously told FierceHealthPayer.

To successfully execute integrated systems, provider organizations will have to appropriate capital in different ways, physician leadership must be able to create clinical teams that embrace cost and care management, and the scale of these efforts will have to grow significantly, Keckley adds.

Even if not all health systems are prepared to fully integrate financing and reform, there are other new models of collaboration between payers and providers, such as contractual network arrangements with equity investment. Provider-owned health plans also are increasing in the Affordable Care Act marketplaces, though in general they still are rare, FierceHealthcare has reported.  

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