Providers with Health Plans

Today's dynamic health care marketplace has created an environment in which some hospitals and health care systems are operating a health plan - either on their own or in partnership - as part of their strategy to advance health in their communities.

Some provider-owned health plans cover just one market segment (e.g., Medicaid managed care) and other plans offer a full portfolio of products for the public and commercial sectors. There are increasing examples of health care systems and hospitals partnering with provider and commercial health plans to offer health insurance products in local markets.

The AHA ensures that all members’ perspectives and needs, including those of members with health plans, are heard and addressed in national health policy development, legislative and regulatory debates, judicial matters, and with the media and consumers.

The AHA has launched the Provider-Sponsored Health Plan Strategic Leadership Group to help develop the AHA’s policy and advocacy agenda specific to this segment of our membership. The Leadership Group also advises the AHA on the products and tools that can assist our members in sharing and developing best practices for business and strategic issues. Read on for valuable information in related resources below. 

Related Resources

Letter/Comment
Public
AHA expresses concerned about some MA plans’ inappropriate restrictions on beneficiary access to medically necessary care, including those highlighted in a…
Fact Sheets
Public
It is broadly acknowledged that Medicare reimburses hospitals less than the cost of providing care and their reimbursement rates are non-negotiable.
AHA Center for Health Innovation Market Scan
Humana recently said it plans to open about 100 new primary care clinics in a second joint venture with the private equity firm Welsh, Carson, Anderson…
Letter/Comment
Public
AHA urges CMS to take swift action to hold Medicare Advantage (MA) plans accountable for inappropriately and illegally restricting beneficiary access to…
Advancing Health Podcast
Public
Medicare Advantage or MA Plans are another way for beneficiaries to get Medicare Part A and Part B coverage delivered through private insurance companies.
Advisory
Member
An arbitrator has ordered that Anthem Insurance Company, Inc. (“Anthem”) pay a group of 11 acute care hospitals in Indiana (“hospitals”) $4.5 million as…