The Academic Payvider Model: Care and Coverage.

Area of Science:

• Healthcare Management
• Health Services Research
• Academic Medicine

Background:

• The US healthcare system seeks improvement to meet the Quintuple Aim.
• Reforming payer-provider relationships is crucial for advancing value-based care (VBC).
• The Payvider model, integrating care and coverage through vertical integration, offers a potential solution.

Purpose of the Study:

• To identify and characterize academic medical institutions adopting the Payvider model, termed Academic Payviders.
• To understand the prevalence and structural characteristics of Academic Payvider systems within the US.

Main Methods:

• Evaluation of all Association of American Medical Colleges (AAMC)-member allopathic medical schools.
• Inclusion criteria: offering both medical care and insurance coverage via payer partnership or ownership.
• Identification of systems meeting these criteria.

Main Results:

• Twenty-five Academic Payvider systems were identified from 171 AAMC-member programs.
• Most systems were founded after 2009 (n=20) and utilized a provider-dominant model (n=17).
• Medicare Advantage was the predominant plan offered (n=23).

Conclusions:

• The rise of Academic Payviders may be influenced by the Affordable Care Act, healthcare consolidation, and focus on social determinants of health (SDOH).
• This movement can drive academic medicine towards greater VBC adoption.
• Potential advancements include innovations in medical education, residency resource stewardship, and administrative leadership.