Hospital-Led Payvider Models: 27% of US Hospitals Now Own Health Plans, Study Finds
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Summary
This study analyzes the growing trend of hospital-led "payvider" models in the US, where hospital systems own health plans (provider-sponsored health plans, or PSHPs). Using 2023 American Hospital Association Annual Survey data across 3,065 hospitals, the research finds that 27.2% of US hospitals now have a PSHP. Key findings include: not-for-profit hospitals (38.8%) and those with medical school affiliations (35.2%) are significantly more likely to own health plans; the Western US has the highest concentration (43.4%); and government and for-profit hospitals have very low adoption rates (8.3% and 4.1% respectively). The article discusses the strategic rationale behind this vertical integration model, including value-based care alignment, financial risk management, and care coordination improvements.
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Twitter / XHospital-Led Payvider Models: 27% of US Hospitals Now Own Health Plans, Study Findsja.maKey quotes
· 3 pulledThe US health care system continues to evolve toward value-based care, with hospital systems increasingly adopting the 'payvider' model — owning both the delivery of care and the insurance plans that pay for it.
Not-for-profit hospitals and those with medical school affiliations are significantly more likely to own health plans, reflecting their broader mission-driven approach to population health management.
The Western US leads in payvider adoption at 43.4%, suggesting regional market dynamics and regulatory environments play a substantial role in shaping these integrated models.
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