n 2012, MedStar Health, like many large employers, struggled to keep up with rapidly rising health-care costs. For three years, the company held down premiums for its 19,000 employees by absorbing the increases itself.

Most employers would have had no choice but to raise premiums - in this case, by about $550 for a family - and cope with frustrated employees. MedStar, one of the Washington area’s largest health systems, saw another option.

It would launch its own health insurance plan, offering it first to its employees. Patients would be limited to MedStar-affiliated providers, and as a result, pay lower premiums. In time, MedStar could compete with the Aetnas and Blue Crosses of the world, offering insurance to the public.

‘By putting in the new health plan, we had the ability to give them an option that actually allowed savings,