The range of provider/insurer configurations

Area of Science:

• Healthcare Management
• Health Policy
• Insurance Regulation

Background:

• Healthcare providers are increasingly exploring integrated models.
• Regulatory and legislative changes are enabling new provider/insurer structures.
• There is a growing trend towards direct contracting with consumers.

Purpose of the Study:

• To examine the emerging trend of healthcare providers forming provider/insurer entities.
• To analyze the legislative and regulatory landscape facilitating these changes.
• To understand the implications of providers assuming full-risk contracts and delegated authorities.

Main Methods:

• Review of current legislative and regulatory trends.
• Analysis of emerging provider/insurer models.
• Examination of "full-risk" contracting and "delegated authorities".

Main Results:

• Legislation and regulations are actively evolving to permit provider-led insurance and direct contracting.
• Providers are increasingly taking on "full-risk" contracts, gaining more control.
• Assumption of "delegated authorities" is occurring with reduced state insurance department oversight.

Conclusions:

• Healthcare providers are strategically positioning themselves to operate as insurers.
• These structural changes aim to enhance direct consumer relationships and operational flexibility.
• The evolving regulatory environment is a key enabler for these transformative shifts in healthcare delivery and finance.