Some health-care systems want to sell you insurance as well as treat you
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Version 0 of 1. In addition to treating what ails you, a number of health-care systems aim to sell you an insurance plan to pay for your medical expenses. With some of the most competitively priced policies available on the marketplaces, “provider-led” plans can be popular with consumers. But analysts say it remains to be seen how many will succeed long-term. It’s not surprising that health systems are getting into the insurance business. Doing so funnels more patients to the organization’s hospitals and doctors. And it makes sense that combining clinical and claims data under one roof could lead to better-coordinated, more-cost-efficient patient care. A number of well-regarded health systems have long sponsored insurance plans, including Kaiser Permanente, headquartered in Oakland, Calif.; Geisinger Health System in central Pennsylvania; and Intermountain Healthcare in Utah. Yet even though health-care systems can gain insurance know-how by partnering with or acquiring an insurer or third-party administrator to handle claims, compliance and customer service, putting it all together can be challenging. “They’re inexperienced,” says Gunjan Khanna, a partner in the health-care practice at the consulting firm McKinsey who co-authored a paper on this type of plan, when talking about newer entrants in this market. “The viability of that business and the ability to manage that is a question.” For example, it may take years to develop the necessary skills in managing financial risk and coordinating patient care beyond the hospital or clinic, among other things. Health plans sponsored by providers are still rare. In 2014, 13 percent of health-care systems in the United States offered plans that covered 18 million members, or about 8 percent of all people with insurance, according to McKinsey. Most of the people covered by provider-led plans are in Medicaid managed-care or Medicare Advantage plans. A growing number of provider-led plans are available on the health insurance marketplaces. When the marketplaces opened in 2014, there were 64 provider-led plans; next year there will be 72, according to McKinsey. In 2016, 19 percent of the new carriers on the exchanges will be provider-led plans. The provider-led marketplace plans are priced very competitively, says John Holahan, a fellow at the Urban Institute’s Health Policy Center. A forthcoming study by the center that looked at 63 areas in 21 states found provider-led plans to be the least expensive in a number of places. For example, Holahan says, a 2016 plan sponsored by Inova Health System, which is headquartered in Northern Virginia, will have the lowest premiums of any silver-level plan in the areas where it is offered. Inova’s Innovation Health plans result from a partnership with insurance giant Aetna.“Because of our strong relationship with Inova we’re able to buy our health care cheaper than most of our competitors,” which helps keep premiums down, says David Notari, chief executive at Innovation Health. An Innovation Health member who lives in Arlington and buys a marketplace plan, for example, has in-network access to all Inova hospitals, clinics and physicians as well as other area providers. Network coverage in provider-led plans varies. Some cover only services within the health system, while others offer more. Consumers have generally been willing to accept narrower provider networks in exchange for lower premiums. “The exchanges have pushed the concept of narrow networks front and center,” says Khanna. Consumers confronting that might want to “consider a provider health plan, because it’s based around a network of providers, and at heart a network is built around a health-care system.” This column is produced by Kaiser Health News, an editorially independent news service. Submit questions to kaiserhealthnews.org/contact-insuring-your-health. |