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The distinction between insurers and hospital systems is fading. What does this mean for physical therapists?

Feature - Blurred Lines 01

The once-sharp lines between insurers, hospitals, and health care practices are becoming increasingly blurred. A growing number of health insurers are buying or partnering with hospitals and medical practices. In turn, some hospitals are entering the field of health insurance. This trend holds significant implications for physical therapists (PTs).

According to the management-consulting firm McKinsey & Company, 13% of all US health systems offer health plans in at least 1 market segment—commercial, Medicare Advantage (MA), or managed Medicaid. A total of 107 systems operate health plans covering about 18 million members, or about 8% of all insured individuals. There are provider-led plans in 39 states.1

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  1. Khanna G, Smith E, Sutaria S. Provider-led health plans: the next frontier, or the 1990s all over again? McKinsey & Company. 2015. Accessed May 6, 2016.
  2. Hayhurst C. Narrow networks: a new challenge for PTs and patients. PT in Motion. 2016;8(1):32-38
  3. Overland D. Aetna partners with Inova in narrow network plan. Fierce Health Payer. Accessed May 6, 2016.
  4. Evans M. Reform update: Anthem's Vivity alliance with seven L.A. systems aims at Kaiser. Modern Healthcare. Accessed May 6, 2016.
  5. Weaver C. Managed care enters the exam room as insurers buy doctor groups. Kaiser Health News. July 1, 2011. Accessed June 1, 2016.

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