Provider/Health Plan Relationships Moving From Dependence To Interdependence

In the not too distant past, the relationship between health plans and the provider organizations that served their members could best be described as a “vendor” relationship. Health plans “shopped” for provider vendors based on service characteristics, location, and price.

But the market changed with the end of preexisting condition exclusions and no annual/lifetime limits – and the move of health plans into Medicaid and Medicare. More members with bigger needs were being served within the health plan. And, the ability of the health plan's network of service provider organizations to manage consumers with high-needs and complex support . . .