Real-world Learnings Behind Successful Provider-Sponsored Health Plans

Establishing new revenue streams and increasing patient volumes are at the forefront of many health systems’ growth strategies. Being able to offer their own provider-sponsored health plan (PSHP) can be one of the most effective ways for health systems to achieve both. The challenge? With so much process, technology, and specialized expertise required to be a successful PSHP, it can be daunting for health systems to develop and initiate a PSHP of their own.

Health systems looking to optimize or start their own PSHP need to effectively manage risk, achieve economies of scale in plan administration, and provide differentiated value in order to compete. This requires a clear view of clinical, operational, and market strengths, as well as a strategy for building, buying, or partnering to implement critical payer functions. Successful PSHPs are also recognizing how advanced data and analytics are playing a central role in optimizing and scaling the health plan. Learning from the first wave of PSHPs can be invaluable as it can illuminate the road ahead for any health system preparing their launch—or pursuing a relaunch—of their PSHP.

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