Hospital-Owned Health Plans: Can a Hospital Effectively Run Its Own Health Insurance Company?

Описание: There are 2 Excellent Papers by Milliman Authors Courtney White and David Hayes on What It Would Take for a Hospital to Run Its Own Health Insurance Plan.

The First Paper Describes Specific Barriers the Hospital Would Need to Overcome:
1) The Appetite for Cost-Control Through Managed Care
2) Start-Up Costs, Initial Financial Losses

The Second Paper Has an Excellent Diagram of How Much Lower the Hospital-Owned Health Plan's Premiums Could Be Based On:
1) Percent Steerage of Plan Members to Its Own Doctors and Hospitals (i.e. Stopping 'Leakage')
2) Percent Decrease in Unit Cost for Services Through Greater Efficiency

If a Hospital-Owned Health Plan Were to Achieve Maximum Results with the Milliman Model, It Would Only Be Able to Offer Health Insurance Premiums That Were 8% Lower Than the Competition.

That's Not That Much.

However, the Milliman Model Does Not Appear to Take Into Account Decreased Hospital Utilization as a Result of Improved Primary Care--as Has Been Implemented by Intermountain Healthcare in Utah.

Intermountain Lowered Hospitalizations by 20%... Could a Hospital-Run Health Plan Do the Same?

Sources: https://us.milliman.com/-/media/milli... https://www.milliman.com/-/media/mill...

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