Expanded services central to CarePoint Health's plans

CarePoint Health's new CEO Dennis Kelly plans to further expand the business beyond its Hudson County, New Jersey, roots while focusing on keeping patients healthy and better coordinating care.

As CarePoint's chief strategy officer since 2012, Kelly has been working with the for-profit organization to better integrate care at its three hospitals and nearly 450 local physicians, reports NJBiz.com.

"Our challenge is providing appropriate care to that population of patients in a cost efficient manner when we know the reimbursement we get is not adequate," Kelly said.

Doing so requires a major investment in technology, he said, to identify those at risk and provide preventive care to keep them out of ERs and hospitals.

Last year CarePoint invested $45 million in the system, including equipment and technology, and expanded physician practices and its surgical practice group.

Previously known as Hudson Holdco, it rebranded itself as CarePoint in May 2013, expanding from a one-hospital operation to a payer-provider organization, offering a Medicaid Advantage plan, sold last year on the federally run insurance exchange. That plan, begun two years ago, now has 3,000 subscribers and will expand to five more counties--making six total--when Medicare enrollment begins Oct. 15.

CarePoint also applied with the state to become a Medicaid provider. Fifty-eight percent of its ER patients, and 38 percent of hospitalized patients are covered by Medicaid, charity care or are uninsured.

With that in mind, CarePoint "has been very deliberate about creating alternate sites of care," Kelly said, creating neighborhood health centers for each of its hospitals and setting up charity care clinics within the hospitals.

Because CarePoint does not participate in most commercial health insurance networks, patients can receive high out-of-network bills, an area under scrutiny in the New Jersey General Assembly.

Competition fostered by the Affordable Care Act favors non-profit health organizations, former Cigna exec and industry watchdog Wendell Potter told Managed Care, as previously reported by FierceHealthPayer. To survive, for-profits will have to diversify by operating outside the United States and expanding their business lines.

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