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By: Nicola Heredia, CHS Marketing Coordinator

The insurance marketplace is getting more diverse in the options available to Americans. Within the last few years, there has been a number of health systems that have broken into this market and started offering their own health plans.

While there is a financial risk with providers developing their own medical insurance coverage to offer to the public, it also eliminates the middle man and gives them more control.

“Insurers have put risk down to providers,” said Gunjan Khanna, a partner in the health care practice at McKinsey & Co, in a Modern Healthcare article. “At what point do providers start to have their own entity to manage the risk and have control?”

Khanna’s consulting firm McKinsey & Co. released a report that surveyed provider-led health plans. According to the study, the number of individuals enrolled in provider-sponsored insurance plans rose from 12.4 million in 2010 to 15.3 million in 2014. The six percent increase in the span of four years is expected to be even higher by 2017.

"This is not for the faint of heart," said Dennis Laraway, executive vice president and CFO of the Houston-based Memorial Hermann Health System, in a Healthcare Finance article. "It's a clear change in strategy and operations from fee-for-service arrangements with third-party payers to the full-risk model of managing to a premium dollar – for both medical and administrative functions."

Although there is a significant financial concern when health systems decide to make this leap into the world of health care insurance, the overall benefits seem to outweigh the risks.

Not only will hospitals and providers be taking back the control from insurance companies, but they have the ability to build a well-rounded health program by including claims processing and data management teams. The opportunity for growth and control over the premium dollar is a driving force behind more provider-sponsored plans from developing, according to the Modern Healthcare article.

“I think the opportunity for payers as they look at this is to understand where they have depending upon their own strategy, the opportunity to support, whether through white label services or through partnerships, some of those providers,” said Jeff Jaymont, Advisory Principal of Health Industries at PwC, in a article.

When developing a strategy to create a structured business model around a newly formed insurance plan, Jaymont recommends six factors to consider.

  1. Previous experience is essential
  2. Strong leadership is key to success
  3. Diverse network of specialties offered to patients
  4. Distinctive and unique brand
  5. Strong financials
  6. Knowledgeable about market position and competition

Once all factors have been evaluated, it is important to create clear, concise goals to ensure that the strategy is specific to that individual health plan. Knowing strengths, weaknesses and obstacles to come provide a realistic view of what is to be expected when developing a health care program.

“If you can demonstrate that you offer more quality at an effective price point, you can take (market) share,” said Joseph Marinucci, a health insurance analyst at ratings agency Standard & Poor's.

Provider-sponsored insurance plans have offered providers another opportunity to interact with their patients. These type of plans are entering the insurance arena and creating more competition, just further proving that health care is always evolving.


By: Nicola Heredia, CHS Marketing Coordinator

As the insurance marketplace continues to get more competitive, plans are looking for ways to attract and retain consumers based on more than just price. With providers focusing on value of care, insurance companies are exploring new ways to engage consumers and make them feel part of the health care process in its entirety.

Patients are continuing to be more active in their health care, where their money is going and how it is being spent. The more informed consumers are; the more insurance plans need to be able to provide them with tools necessary to feel like they are knowledgeable when it comes to their health.

“Health plans, providers and life science companies may be able to accelerate consumer engagement by focusing on developing online information resources, mobile applications and personal health devices that can help individuals in their patient populations and customer bases become more engaged,” reported the Institute of Healthcare Consumerism (IHC).

According to the Deloitte Center for Health Solutions 2015 Survey of US Health Care Consumers, the results of the study demonstrated that engagement of health care consumers is trending up in three specific categories. The importance of a provider/patient relationship, more resources available online and the use of technology are the primary areas that the study found are increasingly important to consumers.

Over the past few years, more of the financial burden has been placed on patients to cover higher deductibles and out-of-pocket costs. As a response to that, consumers are questioning treatment options, in addition to how their health care money is being spent.

“It’s clear that consumers will need significant education, tools and support as they assume more financial responsibility for healthcare costs,” said Steve Auerbach, CEO of Alegeus, in a press release. “Although our index demonstrates that healthcare consumers are making some progress, they still have a long way to go.”

Alegeus, a consumer directed health care solutions company, released their 2016 Healthcare Consumerism Index earlier this month. After surveying over 1,000 American health care consumers, the company reports that although the public may be responsible for paying for more medical costs, there is a lack of tools available to explain and help consumers manage.

Although 76 percent report that they are diligent in getting the best value for their medical dollars, more than half are not clear on what their financial obligation is until the bill comes after the service. This prevents consumers for being able to save or shop around for services.

The report also demonstrated that consumers are more focused on retirement savings over health care, with only 34 percent indicating that they know they should save to pay for health care costs down the road. The lack of knowledge that still exists among the public demonstrate an opportunity for insurance plans to engage with consumers to create financially smarter individuals.

Studies like the Deloitte Survey and Alegeus’ report help identify what insurance companies could be doing better. Memorial Hermann Health Solutions is one company that has looked at different avenues to become more appealing to their consumer base.

“We made a lot of changes to really make sure that we were communicating and approaching individuals on a direct level,” said Neil Kennish, associate vice president of market and sales at Memorial Hermann Health Solutions, in an interview with “What does it cost them? And to try to get away from the vagaries around copays and deductibles. Simplify it for them as much as possible.”

As the insurance marketplace grows with diverse competition, companies must look for ways to separate themselves from other plans offered. Focusing on the customer experience and providing tools to help them manage their financial responsibilities with their own health plan is invaluable.

Click here to get a unique perspective on today’s health care consumer based findings from Deloitte’s 2015 Survey of US Health Care Consumers.



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