N.C. ri­vals watch as Cone Health pre­pares to launch health plan

Modern Healthcare - - REGIONAL NEWS - —Bob Her­man

One large health sys­tem in North Carolina is ready to launch a Medi­care Ad­van­tage plan, and two oth­ers are mulling the pros and cons of en­ter­ing the in­sur­ance busi­ness.

Cone Health in Greens­boro has re­ceived a state li­cense to sell health in­sur­ance, and it’s in the process of re­ceiv­ing ap­proval from the CMS to of­fer Medi­care Ad­van­tage plans. “We think that a big part of that trans­for­ma­tion is be­ing able to in­te­grate the fi­nanc­ing and de­liv­ery of healthcare,” said Jim Roskelly, Cone’s ex­ec­u­tive vice pres­i­dent of strate­gic de­vel­op­ment.

The early suc­cess of Cone’s Medi­care ac­count­able care or­ga­ni­za­tion gave ex­ec­u­tives con­fi­dence that they could en­ter the Medi­care Ad­van­tage busi­ness. The ACO “proved to us that we could be more suc­cess­ful in a riskbased con­tract ap­proach,” Roskelly said.

Char­lotte-based Caroli­nas HealthCare Sys­tem said it has no im­me­di­ate plans to en­ter the in­sur­ance busi­ness. But Caroli­nas CEO Michael Tar­wa­ter said his sys­tem is chang­ing how it works with in­sur­ers, par­tic­i­pat­ing in a nar­row-net­work prod­uct with Blue Cross and Blue Shield of North Carolina and also in bun­dled pay­ment pro­grams for car­dio­vas­cu­lar pro­ce­dures with em­ployer health plans.

Mis­sion Health, based in Asheville, said it would pre­fer to build part­ner­ships with es­tab­lished in­sur­ers. “But that is not to say that we’re rul­ing it out,” said Marc Mal­loy, a se­nior vice pres­i­dent at Mis­sion.

Cone Health ex­pects to start en­rolling Medi­care mem­bers this fall. “If we have cov­ered lives in the thou­sands, we’d be very happy with that,” Roskelly said.

Cone Health in Greens­boro, N.C., has

re­ceived a state li­cense to sell

in­sur­ance plans.

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