MH: You, along with some systems around the country, have gotten into the insurance game. What is your strategy in expanding your presence in insurance?
Lofton: It's a lot about the portfolio. At CHI historically, when you thought about healthcare, the hospitals were the major component and everything was hospital-centric. (Now) we are looking at everything from a continuum of healthcare, and the fact that our role in the future will be to keep people healthy. In order to do that, we have diversified in a number of areas. We acquired a home-care company. We have an invested stake in a reference lab company, as two examples. More recently, we acquired QualChoice, a commercial health plan out of Little Rock. We previously had an invested stake in a Medicare Advantage Plan. It really is just more tools in a toolkit.
We want to look for CHI to move upstream. We are not saying we are going to compete in every market as a health plan. That's really not feasible.
We operate in over 70 communities in 18 states. But what it does say is that in certain markets, it will be beneficial to us to have a health plan as part of what we can bring to the market. You are going to continue to see more direct contracting with companies, and in that case, you really would then be using the insurance company for third-party administration. We now have capabilities in that area to do that.
We also look at our own workforce. We have 90,000 employees. We are self-insured, but yet we pay Blue Cross to be the third-party administrator.
So we will continue to look to have great relationships with the payers in all of the markets that we are in, but at the same time, when it is appropriate or needed, we would be able to introduce our own plan. We currently are processing to have licensures approved in five states.
MH: Do you foresee using insurance to develop a fully integrated delivery system along the lines of a Kaiser Permanente or Geisinger?
Lofton: We have established that in every one of the markets we are in, we will either lead and develop a clinically integrated network (CIN), or become part of one. The key thing is you don't have to own everything.
So, if you take Tacoma, Franciscan Health System is CHI's affiliate up there. We have established a CIN. We have 500 employed physicians in the Franciscan Medical Group but now, through the CIN structure, we have another 500 physicians that have signed up to be part of our integrated network. So we can go to face the market now with 1,000 physicians at multiple hospital sites. We don't have the insurance product, but commercially we do have a Medicare Advantage plan up there.
MH: But is the idea to introduce an insurance product at some point?
Lofton: We don't think that we would have to have an insurance product in every market. In some markets, we are going to have great relationships with the current payers. The key is to switch the model from volume payment to value payment. If we could work those things out with the current payers in the markets we are in, to me, that is the best of both worlds, because we both benefit from keeping people healthy.