A time for reflection: providers rethink plan ownership.

Abstract

Even as recently as a year ago, the buzz in the healthcare provider community continued to be largely positive regarding the development and evolution of provider-sponsored health plans. But recent market shifts and setbacks are forcing a rethinking of the provider-sponsored plan concept. While a small number of such plans in various markets across the U.S. continue to do well, many others are floundering, being sold, or closed down outright. In this article, provider-sponsored plan executives discuss their experiences, and they and industry observers approach questions of whether miscalculations have taken place and continue to take place in this rapidly changing arena of peril and opportunity. In particular, much attention has focused on Medicare provider-sponsored organization (PSO) development under the Balanced Budget Act. But, as industry observers and executives agree, the issues around all kinds of provider-sponsored managed care are now on the table for discussion as never before.