Thursday , November 23 2017
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Health Insurance Exchanges Changing How Hospital Groups Market and Care for Patients

Many health systems’ insurance arms plan to push policies on the new insurance exchanges to expand their base of potential patients…. 

Across the country starting Oct. 1, about 9 million consumers will turn to the new online markets or exchanges to buy health insurance, assuming they are up and running on time. Most will receive government subsidies to help make the plans affordable.

For health systems, the insurance expansion could increase the number of people seeking preventive and primary care, which they previously shunned to avoid medical bills.

This mirrors the strategy long pursued by integrated systems such as Kaiser Permanente. By limiting patients’ choice of hospitals and doctors to their own health systems, it not only creates a captive customer base, but also increases providers’ ability to manage care and costs. The narrow network also allows them to potentially gain more business because they can offer lower insurance premiums, whether it is to the traditional employer market or through the exchanges 

Health systems are being pushed to expand their insurance presence as they are under tremendous pressure to make up for the anticipated loss of revenue that will come from better disease management and care coordination, which will keep more patients at home and beds empty at U.S. hospitals. There will be a drop in demand for high-end services because of more effective care coordination prevention and earlier treatment. The desire is for hospitals and health systems to cultivate ways to fill that excess capacity and continue to be profitable.