Provider Sponsored Insurance: A Scoping Review

Abstract

The passage and implementation of the American Patient Protection and Affordable Care Act (ACA) has ushered in an era of new reimbursement methods and a heightened focus on population health management, which has stimulated U.S.-based health care organizations to contemplate health plan ownership as a logical strategy. The popular industry press regularly reports on health care organizations that are entering and re-entering (and occasionally exiting) the health insurance market. As little research is available on the reasons why a hospital, health system, or physician group would pursue ownership of a health plan in the post-reform era, this article, through a bibliographic scoping review, seeks to shed light on the drivers and obstacles to sponsoring a health plan, as well as the performance implications for health plans and their sponsoring organization in terms of cost, quality, access, and satisfaction.