CHI ex­pand­ing its Medi­care Ad­van­tage plans

Modern Healthcare - - NEWS - By Me­lanie Evans

Catholic Health Ini­tia­tives is rapidly ex­pand­ing its in­volve­ment in run­ning Medi­care Ad­van­tage plans, in­di­cat­ing it will launch plans in four states next year.

The Englewood, Colo.-based sys­tem, which says it op­er­ates 93 hos­pi­tals in 18 states, will en­ter Ad­van­tage mar­kets in Ken­tucky, Ne­braska, Ohio and Ten­nessee af­ter win­ning ap­proval from the CMS and state in­sur­ance reg­u­la­tors. The push comes roughly one year af­ter CHI spent $24 mil­lion to ac­quire a ma­jor­ity stake in an Ad­van­tage plan with 17,000 mem­bers in Wash­ing­ton state.

Juan Ser­rano, CHI’s se­nior vice pres­i­dent of payer strat­egy and op­er­a­tions, said the ex­pan­sion tar­gets mar­kets with fa­vor­able Medi­care re­im­burse­ment rates and where the sys­tem’s hos­pi­tals and doc­tors are ready to man­age the health of en­rolled pa­tient groups.

Ser­rano said the sys­tem’s strat­egy to ex­pand its in­sur­ance op­er­a­tions—which now also in­clude the Arkansas commercial health plan QualChoice —will bet­ter po­si­tion CHI providers to man­age care for the chron­i­cally ill. CHI hos­pi­tals and doc­tors will have ac­cess to mem­bers’ clin­i­cal and fi­nan­cial data col­lected by CHI health plans to help them bet­ter man­age care, he said.

CHI has hired man­aged-care ex­ec­u­tives for their in­sur­ance ex­per­tise, Ser­rano said. “Op­er­at­ing some of our own (health plans) gives us the abil­ity to learn quickly, to move quickly and to ex­per­i­ment with new, in­no­va­tive so­lu­tions,” he said.

CHI lead­ers have sig­naled their de­sire to com­pete in health in­sur­ance mar­kets and use Medi­care Ad­van­tage as a point of en­try. Michael Rowan, the sys­tem’s pres­i­dent and chief op­er­at­ing of­fi­cer, pre­vi­ously de­scribed Medi­care Ad­van­tage as “a low-risk means of get­ting into the in­sur­ance busi­ness.” He also said the sys­tem would launch and ac­quire additional health plans this year.

COO Michael Rowan has called Medi­care Ad­van­tage “low-risk.”

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