Not too long ago, the relationship between health plans and provider organizations was straightforward. Health plans purchased services on behalf of consumers—if they were preauthorized—and provider organizations provided those services in commodity-like network arrangements. Over the past decade, that relationship has changed due to shifts in the market and new competitive pressures on health plans. What are these market factors and what do they mean for provider organization contracting?
More Americans are enrolled in health plans, accountable care organizations (ACO), and other managed care models—There are many more Americans getting their services through health . . .