Why the term “payvider” may not be very useful

“Payvider” is a blended term built from “payer” and “provider,” and it is commonly used to describe healthcare organizations that operate on both sides of the system, with care delivery and insurance capabilities. That can include provider-sponsored health plans and payer-owned care delivery businesses. But the more the term is examined, the less clear and useful it may seem.

Part of the problem is that many healthcare organizations could fit the label if the definition is stretched far enough. If payer and provider roles overlap broadly enough, the word can begin to describe a wide range of companies and systems, which makes it less precise as a category.

Blue Cross Blue Shield of Arizona has said the term emerged in the 1990s, although it did not gain traction immediately. On a 2019 Innovaccer webinar, David Nash, MD, founding dean emeritus at Philadelphia-based Jefferson College of Population Health, said he had first heard the term earlier that year. During that discussion, physicians on the call considered what the word might cover, including risk arrangements, provider-owned plans and other forms of payer-provider collaboration. Dr. Nash said, “I’m not sure what the answer is at the moment,” adding that it was “a relatively new term.”

Even so, the idea behind payviders is not new. Kaiser Permanente, founded in 1945 and based in Oakland, Calif., was built around an integrated model connecting its health plan and care delivery. Bloomington, Minn.-based HealthPartners also has a long history of operating in an integrated way. Other systems often cited in this category include Pittsburgh-based UPMC, Salt Lake City-based Intermountain Health and Danville, Pa.-based Geisinger, which is now part of the Kaiser Permanente family through Risant Health.

The model has also gained attention as healthcare has shifted away from volume-based payment toward value-based approaches. A May JAMA letter cited that trend as one reason for the recent growth in payviders. The same letter noted that the share of U.S. hospitals owning or jointly owning a health plan increased from 18.3% in 2018 to 27.2% in 2023.

The concept is not limited to provider-sponsored plans. Large payers have also expanded vertically into care-related businesses that may include physicians, clinics and pharmacies. UnitedHealth Group’s Optum has about 85,000 employed, contracted and affiliated physicians in its network. Cigna operates Evernorth Health Services. CVS Health’s portfolio includes Aetna and Oak Street Health. Elevance Health has Carelon, and Humana has CenterWell.

At the same time, the meaning of “provider” has itself become less fixed. The Social Security Amendments of 1965 used the term to describe care institutions, while the Social Security Act separately referred to physicians under “medical and other health services.” Over time, Medicare and Medicaid expanded coverage to additional practitioners, including physician assistants and clinical social workers. As the definition of provider changes, the definition of payvider changes with it.

The term also raises questions about health systems that do not own a health plan. Those organizations may still function as payers in other ways because employers remain important purchasers in the healthcare system. Even when a self-funded employer works with an insurance company, it still assumes financial risk, which means the payer label can still apply.

In that sense, the term may be less valuable as a strict category than as a signal of a broader trend: the line between payer and provider is becoming thinner, and healthcare is still working through what both roles mean.