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The Academic Payvider Model: Care and Coverage.

Erika D Harness1, Zachary N Goldberg1,2, Yash B Shah1

  • 1Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.

Population Health Management
|March 5, 2024
PubMed
Summary
This summary is machine-generated.

Academic Payviders, which integrate care and insurance, are emerging in academic medicine. This model, often provider-dominant and utilizing Medicare Advantage, shows potential for advancing value-based care (VBC).

Keywords:
Academic PayviderMedicare Advantageacademic medicinecare and coveragepolicy innovationvalue based care

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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.