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Providers and Payers Make Good Bedfellows

Christopher Cheney, for HealthLeaders Media, February 26, 2014

And having an in-house health plan has helped Sanford Health achieve several healthcare reform goals in recent years, in part because it brings flexibility to help adapt to change, Krystopolski said. "Because we are the payer and the provider, the lines… allow you more room to be creative," she said, citing the health plan's ability to work closely with Sanford physicians if there are complications billing an office visit.

The health plan helped Sanford Health stay ahead of the healthcare reform curve on quality reporting, continuous improvement projects, and comparisons of provider performance. "We had insight into some of the transparency reforms because we had been doing it for a while," she said.

And having the health plan has helped Sanford Health extend access to healthcare services in its market, she said, noting that the petroleum industry boom in the Dakotas has led to a transient segment of the population with few health insurance policy options. "It helps us understand where we might have access challenges," Krystopolski said. "We typically hear of it first at the health plan."

Sanford Health Plan has grown with its partner health system, to about $500 million in 2013 claims since its inception 17 years ago. Krystopolski says selecting good partners has been a key factor in the health plan's success.

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