In an increasingly challenging and competitive healthcare environment, the line between payers and providers has blurred as healthcare entities are trying to more effectively own and control the healthcare dollar.
Successful combined payer-provider enterprises in the form of provider-sponsored health plans (PSHPs) have not only achieved meaningful scale in membership but also have developed the necessary capabilities for population health management, increased the quality of care delivered, and elevated the member/patient experience.
But even with this promise, many organizations have struggled to achieve the anticipated value of an integrated payer-provider enterprise—in large part due to the sheer complexities of such an undertaking, an often-crowded competitive market, and a lack of alignment between the 2 sides of the combined enterprise.
Yet current market dynamics have created a window of opportunity for PSHPs. To take advantage of that window, leaders in these organizations should reevaluate their strategic direction, operating model, and growth tactics.
In this issue brief, we identify 4 key dimensions that require focus and high performance to ensure the success of a PSHP. We discuss the required competencies for each of these dimensions and what it will take to maximize the potential value of this kind of combined payer-provider enterprise.
Several market dynamics have coalesced to create favorable conditions for PSHP growth. PSHPs will likely get more attention in coming years as their relevance and potential value increase.