Prospect Medical Holdings

Richard Asinof, writing for ConvergenceRI, discusses the redefinition of risk as lines blur between hospitals and insurers in Rhode Island and elsewhere.

He notes such developments as   “new Tufts Health Plan partnership with Lifespan to offer a tiered network health plan, known as Lifespan Premier Choice, beginning July 1, where the lowest-priced tier would all be providers within the Lifespan hospital system.”

And “CharterCARE Health Partners, the for-profit joint venture with California-based Prospect Medical Holdings and anchored by Roger Williams Medical Center and Our Lady of Fatima Hospital, is apparently recruiting physician groups in Rhode Island to join in a similar kind of narrow care network….”

Mr. Asinof notes that “the larger question, yet unanswered, pertains to how ‘health’ is defined within the healthcare delivery system and a continuum of care. Is health the absence of sickness as defined by the need for care? Is health defined by social and economic determinants beyond the measurement of the healthcare delivery system?

“As insurers become linked to hospital systems, and as hospital systems become their own insurance networks, and as the risk in the market is redefined as a doctor’s responsibility, how does the consumer play? What is the patient’s voice – other than to fill out a patient satisfaction survey? How do nurses – who hold up more than half the healthcare delivery system – get to play and be rewarded in the new value-based care reward system?”