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Payviders

All articles tagged with #payviders

When a hospital becomes your insurer: early clues from the payvider wave
health-care-policy2 hours ago

When a hospital becomes your insurer: early clues from the payvider wave

Hospitals that also own insurance plans (the payvider model) are becoming more common, potentially improving care coordination but raising concerns about incentives to game risk-adjustment payments and inflate costs. Early data suggest affiliated Medicare Advantage plans can have higher premiums and prices than unaffiliated ones, though explanations vary and many questions remain about overall costs, care quality, and competition. More research is needed to understand the trade-offs.

Hospitals as insurers: the payvider shift reshapes Medicare Advantage
health-policy1 day ago

Hospitals as insurers: the payvider shift reshapes Medicare Advantage

Hospitals that own Medicare Advantage plans—the so-called payviders—now cover about one in six MA enrollees, a shift that can improve care coordination but also risks gaming risk‑adjustment payments and harming competition. Early data show affiliated plans often charge higher premiums and price marks vs. non‑affiliated plans, though some observed benefits include fewer prior authorizations and better care coordination; much remains unknown about the net effects on costs, taxpayer expenditures, and patient access.