By some measures, the Denver metro area is one of the most competitive hospital markets in the country. Big health systems battle it out every year for supremacy in the multi-billion dollar market.
But now, two of those heavyweight health systems — locally based UCHealth and Utah-based Intermountain Healthcare — have decided to… collaborate? Earlier this month the system announced plans for what is known as a “clinically integrated network”.
While it may seem like the hospital giant plans to combine resources on the clinical side, it’s actually more akin to building a giant insurance network. Health systems will remain separate, and they will compete against each other to attract patients.
The new network will bring together nearly 700 primary care physicians, hundreds of clinics and dozens of hospitals – all available and in network for consumers whose health insurance contracts with the new clinically integrated network. And, not coincidentally, the system announced that Intermountain’s SelectHealth insurance plan will be coming to the Colorado market for Medicare consumers as well as people who buy insurance on their own. SelectHealth will use the new network.
UCHealth’s and Intermountain’s respective leaders said the new clinically integrated network will improve the quality of health care that people in Colorado receive while reducing the cost of that care.
“We are excited to partner with Intermountain to advance these goals and give Coloradans a new option for their health insurance,” UCHealth President and CEO Elizabeth Concordia said in a statement announcing the new network. that prioritizes value-based care.” “Together, we will help improve the overall health of the communities we serve.”
But consumer advocates question whether that will actually happen or whether it’s just another ploy by big health systems to get even bigger — and take more money for themselves.
Adam Fox, deputy director of the Colorado Consumer Health Initiative, said, “If they’re using this essentially as negotiating power or as a mechanism to avoid all other insurance carriers, then that’s a concern.” Is.”
How the Clinically Integrated Network will work
According to UCHealth’s Michael Cancro, the new network’s power lies in its size.
Cancro is the Chief Strategy Officer of UCHealth and also serves as the President of the pre-existing UCHealth provider network called Coordinated Care Colorado. That network will merge with Intermountain’s Colorado Quality Care Network to form the new clinically integrated network. The new network will operate as its own company.
Cancrow said this merger does one really important thing: It gives the new network enough patients to do some deeper analysis and provide better service.
“By bringing the organizations together, you have an enormous repository of data as well as the ability to see and identify patients who are at increased risk,” he said.
Cancro said the key to reducing costs while improving care is early identification of patients whose health is going down the drain. But, with a small pool of patients, he said it may be difficult to have enough data to know which signs mean trouble.
The new network’s patient volume means it will collect enough data to conduct more accurate analysis, as well as be able to hire more specialists to do that work.
“Once data scientists have access to a dataset large enough to be able to say this is an indicator and it is not,” he said. “The more life, the better.”
The network will also be able to send alerts to people letting them know when they need to see a doctor about a problem or nudging them to come in for a checkup.
Cancrow said the network will initially provide care for more than 300,000 patients. But Cancrow said more insurers besides SelectHealth are aiming to make deals with the new network, meaning it could bring in more patients. He said it’s also possible that additional doctors’ groups and medical providers could join the network.
Consumer groups hear echoes of hospital mergers
Consumer advocates are skeptical of all these promises. To them, it sounds an awful lot like what hospital systems have said over the years when buying local hospitals or merging with other systems.
Like many other states, Colorado’s health care system is going from strength to strength. And not always for the benefit of the patient’s pocketbook.
A 2020 report from the Center for Economic and Policy Research said, “Hospital consolidation is the biggest driver of prices and operating margins in Colorado’s Front Range counties.”
The new clinically integrated network is not an exact analogue of the hospital merger. But there are enough similarities that people like Robert Smith, executive director of the Colorado Business Group on Health, will only believe his promises of lower prices and better care when he actually sees it. Smith has long been an advocate of reducing the cost of health care in Colorado.
“There is no evidence in the literature that these mergers improve outcomes,” Smith said. “They’ve said it all. But there’s no proof.
What is SelectHealth and when will it launch?
Intermountain is a new player in Colorado’s health care market. Last year, it merged with SCL Health, making it its first presence in Colorado. SelectHealth is the insurance arm of Intermountain — and, like Intermountain and UCHealth, it is nonprofit.
SelectHealth expects to have the plan available for sale in Colorado later this year starting in 2024. It also intends to offer Medicare Advantage plans, as well as insurance in the state’s individual insurance market, through Connect for Health Colorado. insurance exchange.
UCHealth’s Cancro said SelectHealth will not sell insurance in every Colorado county. Instead, it will launch in about 16 to 18 counties, he said. They will be mostly along the Front Range, to match the footprints of UCHealth and Intermountain for their health systems.
First, though, SelectHealth must obtain approval from the state’s Department of Insurance. The Division is reviewing SelectHealth’s application and will announce a decision later this year.
“The DOI is just learning about this joint venture, and we will need to analyze what it entails and the impact it will have on the state’s health insurance market,” Colorado Insurance Commissioner Michael Conway said in a statement. “But, this announcement is a clear indication that Colorado remains a place health insurance companies want to come, and they want to do business in our individual health insurance market.”
Despite the apparent internal connection, leaders at UCHealth and Intermountain said it won’t get a sweetheart deal when SelectHealth contracts with the new Clinically Integrated Network, or CIN, as executives refer to it. .
“CIN will treat SelectHealth like all payers here,” Mark Korth, regional president for Intermountain Healthcare, said in a statement. “Any plan that aligns with CIN’s goals of ensuring improved patient experiences and health outcomes while reducing costs will be considered a valuable partner.”