Hospital Systems and Providers Starting Private Medicare Advantage Plans

How hospital systems are leveraging private Medicare Advantage plans to capture value and control patient outcomes

Published on April 9, 2022

The Provider-Sponsored Plan Revolution

As technology increases and the fight for quality healthcare intensifies, hospital systems and provider groups are increasingly launching their own Medicare Advantage plans. This vertical integration strategy allows providers to capture both the insurance margin and the care delivery margin.

Investment Opportunity

Provider-sponsored Medicare Advantage plans represent a compelling investment thesis for family offices. These entities benefit from existing patient relationships, clinical infrastructure, and data advantages that reduce the traditional barriers to health plan entry.

Technology Infrastructure

Launching a Medicare Advantage plan requires sophisticated technology including enrollment platforms, claims processing systems, provider network management tools, quality reporting capabilities, and member engagement solutions. Our tech stack review evaluates readiness and identifies gaps.

Market Dynamics

Medicare Advantage enrollment continues to grow, with over 50% of Medicare beneficiaries now enrolled in MA plans. Provider-sponsored plans are capturing an increasing share of this growth, particularly in markets where they can leverage brand recognition and existing patient loyalty.

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