Payvider: Health Insurance Payer and Healthcare Provider Combination Explained.

A 'Payvider' is an organization that combines a health insurance company that collects premium and bears risk with a provider of healthcare services (e.g. primary care clinics, specialist clinics, hospitals, etc.)

Kaiser is the oldest and most well known payvider with over 12 million members, 40 hospitals and 618 clinics.

A handful of hospital systems have started insurance companies to become payviders... UPMC and Intermountain are two examples.

Health insurance carriers have placed a major emphasis on becoming payviders.

The reason insurance carriers are so interested in becoming payviders is that revenue from their provider services is not subject to the 85% Medical Loss Ratio that was dictated by the Affordable Care Act.

Therefore, insurance carriers essentially use their insurance money to pay themselves as 'providers' to make additional profits... diverting revenue from traditional hospital systems.

UnitedHealth Group has its Optum provider arm.
Aetna has Oakstreet.
Cigna made a $2.5 billion investment in VillageMD
Elevance (Anthem) has Carelon, which just purchased a healthcare navigation service and a 150 clinic physician practice in Florida called Millenium.

Video on Optum:    • Optum: The $101 Billion Division of U...  
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Sources:
https://about.kaiserpermanente.org/wh...
https://www.upmchealthplan.com/
https://selecthealth.org/who-we-are/a...
https://www.beckerspayer.com/payer/el...
https://www.healthcaredive.com/news/c...
https://www.fiercehealthcare.com/prov...

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