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Biggest Hurdle in Shift to Value? Physician Engagement

By Rene Letourneau  
   October 14, 2015

Ambitious objectives for a health plan are at the center of CHI's strategic vision for the future. Getting buy-in and support from its 4,000-plus physicians is "where the hard work resides," says one senior executive.

In July 2014, Englewood, CO-based healthcare giant Catholic Health Initiatives—which operates 105 hospitals in 19 states—rebranded its insurance arm as Prominence Health and set out on a mission to use its health plan products and services to support the organization's transition to value-based care delivery.  

In addition to operating CHI's commercial and Medicare Advantage health insurance plans, Prominence's goals include aligning and coordinating the system's healthcare delivery networks, data analytics tools, and disease and care management services.

 

Juan Serrano

A Strategic Vision Based on Value

While these may be ambitious objectives for a health plan, they are at the center of CHI's strategic vision for the future. Prominence will serve as a "catalyst to position us as a broadly integrated health system," says Juan Serrano, president and CEO of Prominence Health and CHI's senior vice president for payer strategy and operations.

"I think at the board level our philosophy at CHI is to embrace and support the health plan business because it is relevant to what we believe is the new era of expectation that health systems will integrate care delivery with how healthcare is organized and purchased by employers and consumers," Serrano says.

"That confluence of healthcare delivery and the way customers and consumers purchase and utilize healthcare benefits and services is a critical part of what we think is going to drive the value proposition in the healthcare industry going forward."

To keep pace as healthcare shifts away from traditional fee-for-service payment structures, Serrano says, CHI must find ways to rein in costs while maintaining and improving quality and outcomes. Prominence Health, he says, is a linchpin of that approach.

"We wanted to adapt to take responsibility for the total cost of care. We are being asked by the federal government, state governments, insurance companies, other health plans, and consumer stakeholders to hold ourselves more accountable because what we do relates to their total costs," he says.

"We are escalating our understanding of what it means to integrate providers and a health plan, to operate that plan, and to organize a network and system of care. Along the way, we believe it will make us a better system partner for every stakeholder across the continuum."

Rene Letourneau is a contributing writer at HealthLeaders Media.

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