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Ep. 108: Richard Jones and David Raney on the Provider-Sponsored Health Plan Market

Published on 1/8/2019

Approximately 10,000 people will turn 65 each day over the next 15 years. As 65 is the age of Medicare eligibility, the Medicare market is estimated to expand exponentially.

Today, more than one-third of Medicare beneficiaries have selected a Medicare Advantage health plan as an alternative to traditional Medicare coverage. Compared to a traditional Medicare health plan, Medicare Advantage beneficiaries receive more robust medical benefits, care coordination and other value-added services.

Health systems have started tapping into the value of Medicare Advantage by launching their own provider-sponsored health plans or working with collaborative payers in their market.

In this episode of The Cerner Podcast, we’re joined by Richard Jones, CEO of Essence Healthcare and chief corporate development officer of Lumeris, and David Raney, vice president, CoxHealth Network, to discuss their experiences and success in the provider-sponsored health plan market.

Richard and David answer the following questions: 

  • What is a provider-sponsored health plan and why are health systems pursuing this strategy?
  • What are the intended benefits of a provider-sponsored health plan for members, providers and the health system as a whole?
  • What are the risks associated with setting up a provider-sponsored health plan? How did you overcome these risks?
  • With respect to Medicare Advantage, the Star Rating System is essential for monitoring and measuring performance across plans. What is the significance of this system and what are the keys to success?
  • What advice would you provide to someone who is debating whether to launch a provider-sponsored health plan?

Listen to the full podcast below, or click here to view all episodes of The Cerner Podcast!

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