10 things to know about provider-sponsored health plans

Provider-sponsored health plans have gained popularity among hospitals and health systems in the U.S., as doing so allows the provider organization to plan benefits specifically for their community, and allows health systems to have a role in financing care, among other perks.

Although these provider-sponsored plans are viewed as "the way forward for value-based healthcare" by many, there are still questions surrounding the plans' ability to remain viable long-term, according to a White Paper from The Advisory Board Company, a Washington, D.C.-based research and consulting firm.

The following is a list of 10 provider-sponsored health plans. They are among the larger provider-sponsored health plans.

1. Kaiser Foundation Health Plan

Kaiser Foundation Health Plan, Inc., a nonprofit managed healthcare company, was founded in 1937, according to a Navigant report. The plan offers various services through Oakland, Calif.-based Kaiser Permanente's hospitals and physician practices. The plan has more than 9.3 million members across eight states and Washington, D.C.

2. UPMC Health Plan

Pittsburgh-based UPMC founded UPMC Health Plan in 1998. UPMC Health Plan is an integrated partner company of the UPMC Insurance Services Division, which offers a number of products, including group health insurance, Medicare and workers' compensation. The plan covers nearly 2.3 million members. The local provider network consists of more than 125 hospitals, including UPMC, and more than 11,500 physicians throughout Pennsylvania and parts of Ohio, West Virginia, and Maryland.

3. Healthfirst

Healthfirst was founded in 1993 and is sponsored by various hospitals and medical centers in New York City. Healthfirst has more than 900,000 members and a network of more than 24,000 physicians. The Healthfirst mission is "to provide affordable, quality care for the communities we serve and improve the effectiveness of healthcare delivery by partnering with providers and reinvesting in our member hospitals."

4. Health Alliance Plan

Negotiations between Detroit.-based Henry Ford Hospital, Metropolitan Hospital and Health Centers, and Metro Health Plan, Inc., resulted in Health Alliance Plan in the late 1970s, according to the HAP website. However, the origins of HAP go back to 1956, when the president of the International Union, United Automobile, Aerospace and Agricultural Implement Workers of America (UAW) looked at providing union members with a traditional health insurance alternative, according to the website. The market area for HAP is throughout the state of Michigan, and its total U.S. medical enrollment was 646,000 in 2012.

5. Priority Health
Founded in 1992, Priority Health, the health plan of Grand Rapids, Mich.-based integrated health system Spectrum Health, has plans that cover more than 600,000 people. Additionally, Priority Health coverage is offered by more than 12,000 employers and more than 27,000 physicians and other healthcare providers take part in the Priority Health network, which includes more than 110 acute-care hospitals.

6. SelectHealth
SelectHealth was founded in 1984 by Salt Lake City-based nonprofit Intermountain Healthcare. As of 2012, the plan's medical enrollment was 528,000. "SelectHealth has been committed to helping members stay healthy, offering superior service, and providing access to the highest quality of care," the SelectHealth website reads. "As part of Intermountain Healthcare, SelectHealth shares a nonprofit mission of healthcare excellence."

7. Sentara Health Plans
Virginia Beach, Va.-based Sentara Health Plans, the health insurance division of Sentara Healthcare, operates as Optima Health. The plan was founded in 1984, and as of 2012 its total U.S. medical enrollment was 445,000. Sentara Health Plans offers consumer-driven, employee-owned and employer-sponsored plans, individual and family health plans, employee assistance plans and plans for people enrolled in Medicare and Medicaid, among other things, according to the Sentara website.

8. Metroplus Health Plan
MetroPlus Health Plan, Inc., a prepaid health services plan founded in 1985, New York City Health and Hospitals offers low or no-cost health insurance to those who are eligible in Manhattan, Brooklyn, Queens and the Bronx. That coverage comes through Medicaid ManagedCare, Child Health Plus, Family Health Plus, Medicaid HIV Special Needs Plan (SNP), Partnership in Care, and Managed Long Term Care. According to its website, MetroPlus also offers MetroPlus Medicare Plans as well as MetroPlus Gold, which serves New York City Health and Hospitals employees, non-Medicare eligible retirees, their spouses or qualified domestic partners, and eligible dependents. Included within the MetroPlus network are more than 12,000 primary care physicians, specialists and other providers. MetroPlus' total 2012 U.S. medical enrollment was 438,000.

9. Presbyterian Health Plan

Albuquerque, N.M.-based Presbyterian Health Plan, the health plan of Presbyterian Healthcare Services, is the largest healthcare provider in New Mexico and was founded in 1985. More than 6,000 physicians and healthcare providers participate in the network, serving more than 450,000 enrolled members, according to the HealthPlanOne website. Additionally, Presbyterian Health Plan operates seven New Mexico hospitals. Plans are available for individuals, including those who qualify for Medicaid, Medicare, as well as for employers.

10. North Shore-LIJ Health Plan

North Shore-Long Island Jewish Health Plan is a Medicaid Managed Long-Term Care plan. Services covered by North Shore-LIJ Health Planinclude care coordination, personal care, housekeeping and other household tasks, home-delivered meals, rehabilitation therapies, private duty nursing, dental care, medical and surgical supplies, social day care, and foot care, according to a North Shore-LIJ Health Plan brochure. Members must live in Kings, Nassau, New York, Queens, Richmond or Suffolk Counties, among other eligibility requirements, according to the brochure.


More articles on provider-sponsored health plans:

4 Key Steps for Provider-Sponsored Health Plans 4 Key Steps for Provider-Sponsored Health Plans

Creating Provider-Sponsored Health Plans: Opportunities and Challenges

How Carolinas HealthCare is Integrating Clinical and Claims Data


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