Providers and Payers Make Good Bedfellows
State Regulators as Collaborators
While the health plan has an actuary on staff, Sanford Plan works with the Seattle-based consulting firm Milliman to conduct audits and help develop rates through modeling services. Sanford Health Plan has also had a partnership with Epic to develop an electronic medical records system that connects the health system and the health plan. "The technology is so much better than it was," Krystopolski said, recalling the early days of the health plan when patients would file paper claims. "But I believe we are only at the beginning."
Sanford Health had at least one advantage over current health systems considering the formation of a health plan: a supportive and relatively simple regulatory environment. Krystopolski says state insurance regulators have played a key role in the growth of Sanford Health Plan, contrasting state rules with often burdensome new federal regulations. "They have helped guide us and helped us do the things we had to do to establish regulatory compliance," she said of state officials. "They've been a key collaborator and partner."
As health system executives look for business models that will strengthen their capacity to face industry changes yet to be seen, in-house health plans appear to be a fine companion.
Join our webcast featuring Alan J. Murray, President & CEO, North Shore-LIJ CareConnect as hospital leaders outline the strategic transition from provider to payer, and new opportunities for controlling costs, managing risk, and maximizing reimbursements. March 28, 2014, 1:00–2:30 p.m. ET. Register today.
Christopher Cheney is health plans editor at HealthLeaders Media.
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