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Hospitals Mull Medicare Advantage Opportunities

Margaret Dick Tocknell, for HealthLeaders Media, June 26, 2013

In terms of maximizing market share and margin, Mango said hospitals are most interested in collaborating with an insurer or developing their own Medicare Advantage plans. Collaborating with an insurer has a bit of an edge because although the margins are lower, organizationally, the process is a lot less complex. Mango offered several strategies:

A different kind of competition
Be prepared to "co-pete," a hybrid of collaborating and competing with providers simultaneously. Mango noted that "in their heart of hearts, providers know they don't know how to manage risk and they are really concerned about that. They need help. Offer them a viable alternative."

Consider partnering on a private label basis
Mango said Aetna Accountable Care Solutions, which is offered to hospitals and integrated delivery systems, is almost a private label health plan. The Aetna product is based on aligning incentives such as shared savings so all parties are looking for opportunities to add value to the relationship and provide better patient care.

Take another look
Providers who are unhappy with the contracts they have with other insurers may be willing to partner to improve their margins and market share.

Insurers do need to act quickly, though. Mango noted that hospital and health systems are looking now for partners they can have for several years who can help them achieve sufficient scale to take risk, as well as help to meet the new demands of healthcare service delivery, including the continuum of care.


Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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