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More systems eye entering insurance business



In western North Carolina’s mountains.
One large health system in North Carolina is ready to launch a Medicare Advantage plan, and two others  in the Tar Heel state are mulling the pros and cons of becoming a payer. Cone Health, a $1.4 billion health system in Greensboro,  has received a state license to sell health insurance, and it’s in the process of receiving approval from the the Centers for Medicare and Medicaid Services to offer Medicare Advantage plans to seniors.

Modern Healthcare reports that “Health systems are increasingly jumping into the insurance space. Even though costly information technology and complicated actuarial predictions are large hurdles, organizations view health plans as the missing piece to the population health puzzle. If people in a hospital system’s service area are willing to go to those providers for care, why not offer the coverage to pay for it and keep the healthcare dollar local?””Cone Health runs a Medicare Accountable Care Organization called Triad Healthcare Network, which earned more than $10.5 million in shared savings in its first year. The early success of that ACO gave executives confidence that they could move to the more aggressive, capitated Medicare Advantage structure, in which the federal government pays private insurers lump sums for each member.”

Meanwhile, Mission Health, a $1.4 billion hospital network based in Asheville, is looking into entering the insurance business, though so far anyway,  the  system would prefer to build partnerships with established insurors rather than get into the business directly.

And Charlotte-based Carolinas HealthCare System, the largest system in the state, with almost $5 billion in annual revenue (PDF), also has no immediate plans to build a commercial insurance business.

But, Modern Healthcare reports, “Carolinas is changing how it works with insurers. The system was the first in the state to create a narrow-network product with Blue Cross and Blue Shield of North Carolina, the state’s dominant insurer. Carolinas is also participating in bundled payment programs with local employers, where Carolinas receives a fixed amount of money for certain cardiovascular procedures.”

The routes of 2 ACOs to improve care, control costs


Two Accountable Care Organizations (ACOs) discussed strategies to boost engagement with patients  in order to improve healthcare delivery and outcomes while more rigorously controlling costs.

One is Mercy Clinic ACO, in Des Moines, Iowa, which in 2012 became a Medicare Shared Savings Program (MSSP) participant. The ACO has provider participants throughout Iowa and focuses on primary care,  community resources, patient advisers and health coaches, who are registered nurses.

Mercy also uses  patient advisers to find out what it can do to offer better  service to patients and the broader community, as the imperative of improving population health becomes more pressing.

The Triad Healthcare Network, in Greensboro, N.C., is is also an MSSP ACO participant. Its initial patient-engagement efforts focused on care management for high healthcare users.But that only represented  5 percent to 10 percent of its patient population.

So it reached out  via telephone to “under-utilizers” — patients with chronic illness who haven’t had an appointment in  months. The idea, of course, is to more closely monitor their condition and care to prevent their illnesses from becoming more dangerously (and expensively) serious.




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