Provider-Sponsored Health Plans Go Beyond 80/20 Rule
While some health systems have begun sponsoring their own health plans, making that decision - or entering a shared-risk arrangement with non-provider sponsored plans - requires careful consideration and the examination of several factors.
10 largest health plans account for 43% of 18M covered lives
Next 10 largest plans cover another 20% of lives
Conversely, 10 smallest plans represent only 1% of covered lives
Plans with larger enrollments perform better than plans with lower enrollments: In general, small enrollments correlate to operating losses, high administrative costs, and poor financial performance.
Lines of Business Matter
Variability in performance among PSHPs is significantly impacted by the lines of business pursued and market conditions (opportunity).
The relative scale (enrollment of non-PSHPs in markets where PSHPs compete is a major determinant of the success of the PSHP.