Payer/Provider Link May Get Stronger

Small and mid-size health insurance plans are evenly split on whether to participate in accountable care organizations, according to a recent white paper.

Some regional insurers are “taking charge and forming private ACOs through alliances with regional health systems, individual practice associations, or physician groups,” says “Moving Forward With Reform: The Health Plan Pulse for 2012 and Beyond.” The paper was written by the consulting company Healthcare Technology Management Services (HTMS) for the Managed Care Executive Group, an association of regional and mid-sized health plans (

Of the 61 respondent health plans, 61 percent were not-for-profit while 39 percent were for-profit. The online survey was conducted last year.

“Despite the flurry of attention ACOs have received, however, the responding health plans were split — 47 percent said they were actively planning for ACO development, while a matching 47 percent responded that they were still trying to understand how this new model would fit into their organizations.”

Plans that are part of an integrated delivery system are most actively exploring the ACO path, the study says. Whether ACOs take off or not, respondents expect that more interaction with physicians and other providers will be part of their future.

“When given the opportunity to add or further describe strategic priorities for the upcoming year, a large number of survey participants mentioned partnerships with providers — much more than in previous years. This finding suggests that closer payer/provider relations may become a tactic for potential strategic advantage.”

The plans also look forward to the establishment of state health insurance exchanges, with 53 percent saying that they would help expand membership.

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