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.
