Payor and Operator Models


Rede d’Or’s payors losing market cap

Analysts covering Brazil's largest private hospital Rede d'Or have projected a 25% rise share price after its $2.2bn IPO last month. However, the sustainability of its fee-for-service business model in the long-term has been questioned by some. Its insurers are slowly losing market cap to integrated players.

HBI 2020: Lessons on reaching the patient

An insurer, an integrated healthcare provider and a telehealth player are three providers with very different experiences of being able to reach the patient. HBI looks at four tangible lessons from Aetna, Medicover and Kry from HBI 2020.

HBI 2020: Hospital sector is moving to outcome-based payment – insurers may get left behind

The for-profit hospital sector is moving slowly but inexorably towards value and outcome-linked reimbursement and the role for insurers within that, if there is one, is far from clear. That was the message from HBI 2020's 'Hospitals: The balance of power with payors' session where the CEOs of Mediclinic International and Steward Health Care discussed the topic with an ex-UnitedHealth Group executive.

Private insurance premium inflation down, public up

Private medical insurers will likely drop premium increases over the next 18 months on the back of near-record profitability in 2020. In contrast, public insurers warn that its costs will rise to cancel out growing deficits.

Occupational healthcare “cuts cost of absenteeism by half”

The COVID-19 pandemic shifted the working patterns and environments of every type of workforce, resulting in big hits to free-for-service (FFS) business models and new opportunities in remote care. Panellists from Medicover, Medigold and Qualitas discussed this and how good occupational healthcare can reduce the costs of absenteeism by half, at last week's HBI Big Picture Seminar.

Integrated model ‘alive and kicking’ despite Banmedica closures

Greater scrutiny is being brought to bear on the use of integrated models in Chile - a practice where any impropriety is sidestepped through the use of holding companies. Where does this leave the likes of UnitedHealth Group-owned Banmedica, which has just closed four health centres in its Vidaintegra network - and why is public concern mounting about private insurers profits?

KRY ‘steals’ patients as it moves into capitated model

Swedish B2C telehealth player Kry has registered 14,000 patients in its first health care centre in Sweden, which comes as it's been forced into the capitated funding system. The start-up has been criticised for not making it clear enough to patients that they would be de-registered from their physical healthcare practice.

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