April 2012

New Subsidiary to Support Payer Strategy and Operations


CHI is consolidating its Managed Care Operations and Payer Strategy functions to provide better support for national, divisional and MBO payer strategy, risk and insurance programs, and managed care operations.

The expanded national Payer Strategy and Operations organization will be structured as a subsidiary. “This will allow us more flexibility in several areas, including enabling CHI to support population health management operations for our own employees while meeting all HIPAA privacy requirements regarding their personal health information,” said Dean Swindle, executive vice president of business services and chief financial officer.

Highlights of the Payer Strategy and Operations team’s new responsibilities include:

Population health management operations. Population health management refers to risk-based and value-based health products and programs that serve defined populations. Defined populations include people enrolled in specific benefit plans, patients in care programs for similar diagnoses and conditions, and people who identify with the same provider networks and medical homes. The new subsidiary's services will enable CHI to use population health information management tools, implement interventions to support the health of individuals and communities, assume and manage economic and insurance risk, and support care management programs. In turn, these services will help CHI develop models that will serve communities' population health management needs.

Managed care and strategic payer relationships. The move toward population health management and accountable care requires CHI to enhance payer relationships, strengthen managed care contracting and operations, and support emerging risk-based and value-based accountable care models. “Customers – including employers, insurers, government sponsors and individual consumers – have increased expectations for health provider accountability for quality, affordability, service and convenience,” said Swindle. “The new subsidiary will help CHI facilities take a more strategic, information-oriented and value-based approach to contract negotiations and relationship management with payers and customers.”

Population health business services for internal and external customers. The new subsidiary will support population health management solutions for beneficiaries of CHI’s benefit plan, beginning in calendar year 2013. The subsidiary will also respond to customer requests for value-based contracts and products.

Juan Serrano, formerly vice president of managed care operations for the East/Southeast Division, will lead the new subsidiary, reporting to Swindle. He will be based in the Denver national office. “We’re now working with CHI national and market-based leaders in managed care, finance, clinical care, physician practice management, strategy, legal and other key areas to define processes and implementation plans for our CHI payer strategy and managed care operations,” said Swindle.

For more information, contact Juan Serrano.