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

[@bryanh8292]

Good lord the tables are about to be turned 180 for the specialists. All my med school peers preached about how going the specialty route was superior to primary care... I am glad I went the primary care route considering the paradigm shift we are about to witness in healthcare these coming up years. Great info keep it coming!!

[@ahealthcarez]

Thank you for watching and for your comment. Not sure when or if tables will turn. Many forces against it. 🤷‍♂️

[@bryanh8292]

@@ahealthcarez I agree the tables may not turn but it's definitely about to become an uphill battle for specialist and I can see how health networks will skimp out on capitation contracts for primary care doctors.

[@liberoAquila]

Isn't the system moving towards PAs and NPs in primary care as some states are granting full practice privileges.

[@LisaMitchellGD]

@@bryanh8292 there is no way this hair brain greed inspired scheme is a good idea

[@14thSun]

I enjoyed reading about the pesants revolt of 1381 and I look forward to reading about the specialists revolt of 2021.

[@ahealthcarez]

Let me know when you see the article. 😉 Appreciate you watching.

[@LisaMitchellGD]

@@ahealthcarez this is so shady and not kosher. It is a major conflict of interest and I am really surprised this is legal

[@tedryan2798]

As a 30 year veteran of the managed care wars (sales, underwriting, network management), I find these videos incredibly accurate and insightful. Keep up the good work!

[@ahealthcarez]

Appreciate the positive feedback. Thank you for watching.

[@tedryan2798]

@@ahealthcarez One last comment….Having been in the Fortune 500 world and hospital based world, it is easy to understand why hospitals eventually give up the ghost and sell the membership to a Fortune 500 in exchange for a favorable in-network agreement. I have been on both ends. There are a few exceptions (Intermountain, Geisinger, UPMC,etc) but culturally, hospitals can’t maintain the balance that is required to manage both.

[@LisaMitchellGD]

​@@tedryan2798 Oh this sounds like a recipe for disaster

[@Vein911]

Excellent explanation of why most hospitals have failed at Fee for Value care models and struggle with being their own insurance company. Every hospital system in America is desperately pivoting to becoming a health insurance company. They are using their own employees as guinea pigs. Changing a fee for service hospital culture to fee for value culture of cost control is a heavy lift, and predictably, a likely impossible lift.

[@liberoAquila]

In Pittsburgh we have really bad blood between UPMC which has entered the insurance market and Highmark BCBS which is an insurer who entered the hospital market by acquiring AHN. Both are "non-profit".

[@ahealthcarez]

Thank you for watching and sharing your perspective.

[@LisaMitchellGD]

"nonprofit " like the "Church of Scientology* right ? Just means tax exempt status right ? I fly outta Pittsburgh,closest international airport to me in West Virginia

[@railzip]

This is such great content. Please keep them coming

[@ahealthcarez]

Thank you for watching and for your feedback.

[@mohammadpirzadah638]

You are awesome. Thanks for your amazing enlightening videos.

[@ahealthcarez]

Thank you for watching and for your feedback.

[@scottmcclave3583]

I have historically been pretty skeptical of hospitals entering the health plan market because, well, anytime a hospital make a somewhat dramatic change I generally assume they're just looking for ways to squeeze more money out of the general public. But I like this angle of supporting the concept because it in some way forces hospitals to adopt things like cost-based accounting in order to even have a remote chance of competing in the marketplace. This obviously won't be possible for all hospitals (some are simply too tragic). If Kaiser can be considered a long term case study as a success in this area, I think there are some interesting pros and cons of the model as a whole. And to that last point of specialists revolting due to a decrease in their utilization: any specialist who derives their professional value from simply doing high volumes of whatever they do: let them go elsewhere and suggest the door doesn't hit them on their way out.

[@ahealthcarez]

Awesome! Appreciate you watching and leaving such a thorough comment. 👍

[@LisaMitchellGD]

Theyre so greedy though

[@sushibooshi]

Great info!!!

[@ahealthcarez]

Thank you for your feedback.

[@brucebabbitt3540]

Very good. I worked 6 years for a hospital owned health insurance plan. Very effective and a great competitor to BUCAs. Sold as a high performance network or combined with other networks. Kaiser in California is another good example and may have been the model for the 73 HMO act. I agree the major challenge is high capital start up costs. Thanks for the video.

[@ahealthcarez]

Thank you for watching and sharing your experience.

[@LisaMitchellGD]

😂😂😂sounds like a scam! A hospital and insurance company are not supposed to be the same entity

[@LisaMitchellGD]

😂😂

[@LisaMitchellGD]

Corporate greed

[@hovamojo3117]

Did Intermountain lose their top specialists when they lowered their utilization?

[@ahealthcarez]

Great question. I believe they did not on account of their patient-centric culture.

[@hovamojo3117]

@@ahealthcarez thank you. Can you make a video on the finances of healthcare for self employed people? maybe you already have one.

[@christyhowell]

@@ahealthcarez What other health systems would you describe as patient-centric?

[@1973MADCOW]

FYI my fellow Milliman colleague Courtney White is a fine southern gentleman.

[@ahealthcarez]

Thank you. Yes. My apology. I made a horrible mistake.

[@bdene112]

… ok but what about medication coverage? I’m all for staying in my health care system for providers, but who is going to advocate to cover expensive meds?

[@LisaMitchellGD]

Seems very conflict of interesty to me . I don't like it. Too much corporate giant

[@ahealthcarez]

Thank you for sharing your thoughts.

[@LisaMitchellGD]

@@ahealthcarez You're welcome ! I absolutely LOATHE greedy American corporate healthcare monopolies !

[@LisaMitchellGD]

@@ahealthcarez how is this not a massive conflict of interest for a healthcare provider and insurance company to be the same entity? What a joke

[@suemilkbone4868]

​@@LisaMitchellGDMy thoughts exactly. There are no checks and balances in this health care format.

[@LisaMitchellGD]

@@suemilkbone4868 Thank you ! Im glad Im not the only one suspicious of this ! Sounds like corporate greed at its finest , and like you said, no checks and balances. They are just in it to maximize their profit and I see no real benefit to patients or the general employee population. And when they claim "nonprofit" a lot of the time all that really means is they have tax exempt status, kind of like the " Church of Scientology" who is very for profit