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Shared-Risk Strategies

John Commins, for HealthLeaders Media, April 15, 2013
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Juan Serrano
Senior Vice President,
Payer Strategy and Operations
Catholic Health Initiatives
Englewood, Colo.

We are making a concerted shift to changing our model from being hospital-centric to being a clinically integrated model that involves our physician ambulatory services and our hospitals because clinical integration is an important precursor to realigning incentives. Throughout this year we will have significantly shifted our focus toward clinical integration.

Second, we have population health data management capabilities. We are using a couple of different solutions to support people who either are already at risk or came from some form of performance-based accountable risk.

We have brought on board underwriting and risk management operations that are building a bridge to span the structure from healthcare delivery to health plans. And we have capitation management infrastructure such that when we ask stakeholders in our health system to assume responsibility for pay-for-performance—that if we take a capitation rate or if we simply want to manage a risk pool for which they are accountable—we are able to monitor that performance and distribute payment or incentives accordingly.

We are already in a number of performance-based payment programs.

So we are on a pace that coincides with the rate in which the industry is transforming. When we are presented with opportunities to evaluate a risk-based model we have the skills, the tools, and the people with which to move into that space.

John Commins is an editor for HealthLeaders Media. He may be contacted at jcommins@healthleadersmedia.com.

Reprint HLR0413-1


This article appears in the April 2013 issue of HealthLeaders magazine.


John Commins is a senior editor with HealthLeaders Media.

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