Vital signs: What to consider before launching a provider-sponsored health plan in the New Health Economy

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Today's New Health Economy demands that providers shoulder greater risk. In response, health systems and physician groups contemplate taking full control of the healthcare dollar by launching their own health plans. However, doing so successfully requires having the right capabilities and a cohesive strategy.

What this means for your business

  • Measure your investment needs. Starting a health plan requires significant upfront investment with profit likely years away. Systems should carefully evaluate their potential return before leaping.
  • Take stock of the environment. Not all markets are conducive to launching a health plan. Health systems should consider scenario planning to assess the readiness of their market and to map out potential responses from other market players.
  • Define your purpose, and then execute on it. Health systems must identify why they want to start a health plan, and then pick a plan model, growth strategy and infrastructure investments that support that goal.
  • Tout your unique advantage – trusted brand, niche offerings and community presence. Provider-sponsored health plans can differentiate themselves by delivering more innovative health plan products and value-based reimbursement models tailored to their communities.
  • Deepen relationships with other insurers. Health systems with provider-sponsored health plans should maintain relationships with insurance companies and find opportunities to work together in collaborative models.



Contact us

Benjamin Isgur

Benjamin Isgur

Health Research Institute Leader, PwC US

Trine K. Tsouderos

Trine K. Tsouderos

HRI Regulatory Center Leader, PwC US

Tel: +1 (312) 241 3824

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