How can the integration of a payer and a provider create value in health care?

Integration between the payer (i.e., an insurer) and the provider (i.e. a hospital) of health care services provides a promising method for implementing value-based health care as incentives and processes align among different stakeholders. However, such integration may also cause distrust and fear of poor quality among patients, and thus, decrease customer value. To solve this paradox, we conducted a sequential explorative mixed-methods study of Pohjola Insurance Services, the largest occupational trauma insurer in Finland, which runs its own hospital to increase the value of the care provided. We derived four propositions suggesting that integration can increase value for multiple stakeholders by shifting the focus from an operations-centric mindset to an approach that emphasizes customer service and effective recovery. The approach seems to reduce unnecessary operations further shortening the duration of sick leaves and decreasing the total cost of occupational accidents. We tested serial multi-mediator model with a sample of 2762 occupational accident patients. The results provide empirical support for this rationale and show that the investigated integrated delivery model led to a 9% decrease in the average total costs for an occupational accident.