Is a Hospital-Sponsored Medicare Advantage Plan Right for Your Organization?

November 19, 2019

// By Wendy Stark Healy //

Wendy Stark HealyMedicare Advantage Plans have become a popular choice among Medicare recipients, and health systems are staking their claim to the market. Some health systems have had insurance arms for years, and others are just launching their plans. Done correctly, hospital-sponsored Medicare Advantage plans offer an attractive opportunity for health care organizations. What does it take to succeed?

John Lovelace, president of government programs at UPMC Health Plan

John Lovelace, president of government programs at UPMC Health Plan

Hospital and physician-owned Medicare Advantage (MA) plans have seen double-digit growth since 2015. Axios, which tracks membership data from the Center for Medicare and Medicaid (CMS), reports that the largest organization in this category, Kaiser Permanente, grew 23 percent from 2015 to 2018, to almost 1.6 million members. The other 40 or so hospital- and physician-owned plans have also burgeoned, some by more than 40 percent.

With the 2020 Medicare Open Enrollment period ending this month, we asked three health care organizations offering MA plans — UPMC, Henry Ford Health System, and BayCare — why they’ve had such robust growth:

Health systems acquiring, starting, or partnering with insurers is a growing trend, according to John Lovelace, president of government programs at the University of Pittsburgh Medical Center (UPMC) Health Plan in Pennsylvania. “The alignment of payer and provider is growing,” he says.


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