Modern Healthcare - - REGIONAL NEWS -

RO­SEVILLE, Calif.— Ad­ven­tist Health, a Cal­i­for­nia-based health sys­tem with 18 hos­pi­tals in four states, plans to seek Cal­i­for­nia’s ap­proval for an in­sur­ance li­cense be­fore the end of the year. It would be Ad­ven­tist’s first in­sur­ance li­cense, though it will be a limited li­cense. An in­sur­ance li­cense will bet­ter po­si­tion the health sys­tem to take on fi­nan­cial risk for pa­tients’ care un­der new, global pay­ment con­tracts with pri­vate in­sur­ers, Medi­care and Med­i­caid that have emerged across the in­dus­try and un­der the Pa­tient Pro­tec­tion and Af­ford­able Care Act, said Jeff Con­klin, Ad­ven­tist Health’s vice pres­i­dent of payer and net­work strate­gies. Ad­ven­tist will seek a limited li­cense that would al­low it to en­ter into con­tracts with more fi­nan­cial risk, but does not al­low Ad­ven­tist to sell in­sur­ance di­rectly to con­sumers, he said. The sys­tem joins a num­ber of other health sys­tems with re­cent deals or plans to ac­quire nec­es­sary state ap­proval for health plan op­er­a­tions, ei­ther by seek­ing a li­cense or by ac­quir­ing an in­surer. Steve Nolte, CEO of Sacra­mento, Calif.-based Sut­ter Health’s in­sur­ance arm Sut­ter Health Plus, said the sys­tem sought to gain more di­rect con­trol over the de­liv­ery and fi­nanc­ing of health­care with its newly li­censed in­sur­ance op­er­a­tions, which will launch its first health plans next Jan­uary. Data cap­tured by the in­surer will bet­ter in­form ef­forts to iden­tify qual­ity and ef­fi­ciency gains, he said, which ap­pears to be “the mis­sion of re­form.” — Me­lanie Evans

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