Notably, more than one in ten health plans started between 1957 and 2017 were no longer active in 2024. Despite potential cost-saving benefits, PSHPs have delivered mixed results. Only four of the 43 PSHPs formed or acquired between 2010 and 2015 were profitable in 2015.1 The disappointing financial results were attributable to a variety of factors, including difficulties in scaling, marketing, enrollment, hyper-regional focus and regulatory compliance.
Even profitable plans have seen revenue fluctuations, creating uncertainty around their viability as a revenue diversification strategy. Despite their inconsistent operating results, PSHPs remain a cornerstone of many health systems’ strategies. Therefore, we analyzed enrollment, market share and the types of insurance products offered by various health systems to understand the current landscape and challenges faced by PSHPs.
Health System Trends
In 2022, 197 health systems, representing 31.1% of all U.S. health systems, offered PSHPs (Figure 2). Of these, 120 (18.9%) offered Medicare Advantage (MA) plans, 85 (12.5%) offered Medicaid managed care plans, 79 (12.5%) offered Marketplace plans and 54 (8.5%) offered all of the above. Notably, prominent health systems such as Kaiser Permanente, UPMC, Baylor Scott & White and NYC Health+Hospitals offered MA, Medicaid and Marketplace PSHPs in 2022.