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October 29, 2018

PYA Publishes New White Paper: “Pursuing a Provider-Sponsored Health Plan: Key Considerations”

PYA has released a white paper offering insights and key considerations for providers pursuing provider-sponsored health plans as opportunities for effective population health management.

PYA has recently released a new white paper, “Pursuing a Provider-Sponsored Health Plan: Key Considerations.”  Born from a sustained emphasis on value over volume in the reimbursement arena, the white paper delivers insights on provider-sponsored health plans (PSP) and offers vital points to consider when determining if a PSP is a good fit for a provider organization.

According to the white paper, “It takes time and commitment for physicians and health systems to build the infrastructure and master the competencies required for value-based payments. . . .  During this learning and development phase, providers look to partner with payers, moving from no-risk to shared-risk models. . . .  A [PSP] offers these organizations the opportunity to reap the benefits of efficient operations and effective population health management strategies.”

This guidance for provider organizations illustrates five key considerations for evaluating the PSP opportunity—business strategy, provider network composition, service area, products and populations, and operational structure.  It also outlines differences between a PSP and a joint venture health plan—and how to evaluate those differences during the planning phase of developing a PSP.

Although PSPs are ideal structures for organizations with efficient operations and population health management competencies, the paper suggests that jumping into them too quickly or without adequate research could pose a risk.  “Provider organizations have spent decades developing strong connections with the communities they serve.  Taking the leap into the payer space builds on those relationships, giving providers greater leverage to transform healthcare delivery and improve community health.  Taking that leap before the organization is ready, or without appreciation of potential landmines, however, could result in long-term problems and significant economic risk.”

With decades of healthcare advisory experience, PYA assists healthcare organizations in evaluating the PSP opportunity—from strategic evaluation to PSP build-outs and implementations to operational assessments of existing plans.

 

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