One-Third of U.S. Health Systems Offered a Health Plan in 2018

One-Third of U.S. Health Systems Offered a Health Plan in 2018

Published: Aug 23, 2021
Publisher: Mathematica
Associated Project

Coordinating Center for Comparative Health System Performance

Time frame: 2016-2021

Prepared for:

U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality


Michael F. Furukawa

Daniel Miller

Key Findings
  • Of 597 systems in 2018, 34 percent (200 systems) offered a health plan.
  • Close to 20 percent of systems offered each of the following: Medicare Advantage (MA), Medicaid managed care, large group, and small group plans.
  • Larger systems and systems that covered a larger geographic area were substantially more likely than smaller systems to offer a health plan.
  • Church-owned and investor-owned systems—which tended to be large and operate in several states—were more likely to offer a health plan than other systems. Systems with higher teaching intensity were more likely to offer a plan.

As consolidation of hospitals and physicians into vertically integrated health systems has increased in recent years (Furukawa et al. 2020), debate over the net benefits of health systems has grown. The promise of health systems was greater ability to provide efficient, population based care, but the reality to date has been higher prices and few, if any, gains in quality (Machta et al. 2019). Another avenue by which systems might affect patients’ outcomes and expenditures is by offering health plans (Meyers et al. 2020; Orszag and Rekhi 2020). Investing in health plans might offer a number of advantages, such as the ability to more fully benefit from value-based population health efforts by the system (Wrobel 2017). Little is known, however, about how many and which types of systems offer health plans. This analysis leverages new data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of U.S. Health Systems to describe the percentage of health systems that offered a health plan in 2018 and the system characteristics associated with offering any health plan and by type of plan.

How do you apply evidence?

Take our quick four-question survey to help us curate evidence and insights that serve you.

Take our survey