The Rise of Medicare Advantage Payviders

The term payvider has recently emerged to refer to financial integration between a health care payer and a provider organization. The substantial growth in Medicare beneficiaries participating in Medicare Advantage (MA) plans could be accelerating the integration of MA payers and providers. Using data from the AHRQ Compendium of U.S. Health Systems, we describe growth in health system ownership of MA plans and of MA plans control over clinicians, especially in primary care. We summarize findings from the literature and describe patterns in growth of MA payviders suggesting health plan investments in payviders might reflect a strategy to maximize MA payments through enhanced documentation by primary care clinicians. Updated data will be needed to track changing ownership of primary care practices and MA plans. Future analyses could clarify the effects of health systems’ and MA plans’ evolving control of primary care and inform policies to ensure these growing MA-oriented payvider arrangements advance the value of health care for Medicare beneficiaries.