Health care giants form one insurance company

Question is who benefits

BY JOHN INGOLD THE COLORADO SUN

By some measures, the Denver metro area has one of the most competitive hospital markets in the country. Large health systems duke it out every year for supremacy in the multibillion-dollar marketplace.

But now, two of those heavyweight health systems — locally based UCHealth and Utah-based Intermountain Healthcare — have decided to … cooperate? e systems earlier this month announced plans to form what is known as a “clinically integrated network.” e new network will bring together roughly 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 systems announced that Intermountain’s SelectHealth insurance plan will jump into the market in Colorado for Medicare consumers as well as people who buy insurance on their own. SelectHealth will utilize the new network.

While that may sound like the hospital giants are planning to combine resources on the clinical side, it’s actually more akin to forming one giant insurance network. e health systems will remain separate, and they will continue to compete against one another to attract patients.

UCHealth’s and Intermountain’s respective leaders said the new clinically integrated network will improve the quality of health care that people receive in Colorado while reducing the costs of that care.

“We are excited to partner with Intermountain to advance these goals and to give Coloradans a new option for their health insurance that prioritizes value-based care,”

Elizabeth Concordia, UCHealth’s president and CEO, said in a statement announcing the new network. “Together, we will help improve the overall health of the communities we serve.” according to UCHealth’s Michael Cancro, is in its size. e key to reducing costs while improving care is to identify patients early whose health is heading down the wrong path, Cancro said. But, with a smaller pool of patients, he said it can be di cult to have enough data to know which signals mean trouble. e patient volume of the new network means it will gather enough data to conduct more precise analysis, while also being able to hire more experts to do that work.

But consumer advocates question whether that will actually happen or whether this is another play by large health systems to get even larger — and take more money for themselves.

“If they’re essentially using this as negotiating power or as a mechanism to shirk all other insurance carriers, that’s a concern,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative.

Cancro is UCHealth’s chief strategy o cer and he also serves as the president of an already-existing UCHealth provider network called Coordinated Care Colorado. at network will merge with Intermountain’s Colorado Quality Care Network to form the new clinically integrated network. e new network will operate as its own company.

Cancro said this merger does one really important thing: It gives the new network enough patients to start doing some in-depth analyses and also provide better service.

“By bringing the organizations together, you have a pretty vast trove of data as well as the capability to look and identify those patients who are rising risks,” he said.

“Having access to data scientists, having access to large enough datasets to be able to say that this is an indicator and this is not,” he said.

“ e more lives, the better.” e network will also be able to