Reimbursement
President says signing up younger and healthier enrollees improves the risk pool.
Running its own health plan has allowed Marshfield Clinic to design a value-based reimbursement model that rewards physicians for quality, clean coding and cost maintenance.
While value-based care is making the move more attractive, getting an insurance product off the ground isn't the easiest.
Health system-owned plans now represent 52 percent of health insurance products, AIS said.
Medicare already plans to stop paying certain hospital-owned physician practices at higher rates than those that are independently owned.
Insurer drew attention two years ago as the only Affordable Care Act co-op to make money from its exchange products, reporting a net income of $7.3 million in 2014.
A higher chargemaster price can increase the payment from private insurers, which often pay for outpatient and ancillary services based on discounted chargemaster prices.
Consumers Union wants to know why the cost projections submitted by Anthem and Blue Shield are so much higher than some of their competitors and other industry-wide figures.
Aetna, however, said many insurers have been forced to leave the exchanges due to what it called the instability of the marketplace.
Hospitals that perform joint replacements on older, sicker patients under the program will suffer under reconciliation payment reductions, research suggested.