- Premier Health, the largest hospital network in the Dayton, Ohio area, now offers insurance coverage to its own employees. Premier has announced it will be expanding next year into the state exchanges, private and group markets outside of the exchange and Medicare Advantage plans.
- The health plan will operate as a separate business unit from the hospital system. The network will not be limited to Premier providers, but will have more than 3,300 community providers at different treatment facilities in the area.
- The organization will be expanding to make the change but it has not given data regarding the number of jobs that will be added. The city will soon be the headquarters of two of the biggest nonprofit organizations in the market.
According to the Washington Post, in 2013 28% of hospitals were expecting to launch their own plans over the next five years and 18% had already dipped into the business.
The WaPo article asked "Is this the end of health insurers?" when MedStar Health decided to launch its own insurance plan to reduce the health costs of its employees. This hasn't been the case, but hospital systems all over the country are beginning to understand that investing in insurance may be a good business move. Hospitals can invest premium money where it can do the most for employee health and they can benefit from brand recognition to attract patients. They become the greatest recipient of reducing costs in the system, and perhaps most importantly, they have complete care data on an individual patient. Provider data on a given patient is historically limited to care received at their facility, making risk assessments and preventative care more difficult.
There are some risks to hospital-insurer integration—as shown by the longstanding dispute in Pennyslvania between Highmark (the dominant health insurer) and University of Pittsburgh Medical Center (the dominant health system)—but some believe that provider-payer integration, or at the very least collaboration, will improve costs and outcomes across the system. According to Brad Sitler, the principal industry consultant at the SAS Center of Health Analytics and Insights, creating a population database that is predictive of patient outcomes is dependent on combining EMR data with more-complete payer data.
"If you have a provider and payer who have a non-strained relationship and they could strike up a deal to share data, you could actually have a holistic view of a patient," Sitler told Healthcare Dive. "You could start leveraging that data today to start building risk strata, and start looking for patients that are on the trajectory to becoming high risk. That data is very predictive."
Want to read more? You may enjoy this article about the Highmark Health gamble: How risky is hospital-insurer integration?