Summary
A Portland-based urgent care operator is launching a health plan from scratch
The strategy targets the busy and healthy with the convenience of a retail network providing “store brand care”; …
A few days ago, Cleveland Clinic announced the formation of the Midwest Health Collaborative (“the Collaborative”), a new company jointly managed by six Ohio delivery systems across the state. The co…
In theory, narrow networks built around a single provider or a network of aligned providers (“provider-orchestrated narrow networks” or “ACO networks”) can pose a much higher stakes threat to non-part…
Summary
Boeing is creating a benefit design model which sets up providers to compete for their book of lives via provider-branded narrow networks
By offering a choice among competing narrow and full …
Summary
Aetna is stitching its inventory of ACO deals into a national ACO network and will offer them on its proprietary private exchange (PHIX)
Linking ACOs and PHIXs is smart because PHIX’s defined…
Last week, I argued that, if payers want to secure competitive advantage from improved provider care, they would need tighter, more exclusive alignments with these providers to “crowd out” the free ri…
A new study in JAMA (by McWilliams et al.) looks at the Medicare expenditures of patients seeing providers enrolled in the BCBS of Massachusetts version of the ACO (Alternative Quality Contract or “AQ…
Earlier this month, Heartland Health signed a deal with the Mayo Clinic for its doctors to virtually consult cases with Mayo physicians in return for an undisclosed fee. Heartland Health is a reg…
Yesterday, Aetna announced a deal with Heartland Health (an integrated delivery system serving northwest Missouri, northeast Kansas and southeast Nebraska) to create a new health plan for the small gr…
A recent article in the NEJM argues that cost savings from
quality improvements are illusory because of the lumpy nature of healthcare
capacity. Quality’s impact on
utilization is just too small…
Kaiser’s latest employer benefits survey offers some interesting data on the adoption of narrow (or high performance) network products. See chart below:
Couple of observations:
Overall adoption at …
The Stewards-Tufts deal announced today will create a narrow network insurance product targeting the small group segment. As reported, members covered by the plan must get all routine care from Stewa…
Much of the public speculation (for example here and here) regarding the acquisition of a local high quality safety net health plan -- is it about locking in Medicaid volume? or about doing a “good de…
Summary
The line between health plan and provider continues to evolve: the Aetna-Carilion deal exemplifies providers backward integrating into insurance (and contrasts with other providers exit…
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