Intermountain's insurance plan is 'biggest opportunity for growth,' CFO says

Janie Wade was appointed CFO of Salt Lake City-based Intermountain Health after more than four years as CFO at Broomfield, Colo.-based SCL Health. 

Last April, the two systems merged into a 33-hospital entity that includes 59,000 employees, a medical group with more than 3,800 physicians and advanced practice providers and an insurance plan with more than 1 million members. 

Ms. Wade spoke to Becker's Hospital Review about Intermountain's top priorities in 2023, the growth of its insurance plan and the importance of innovating and simplifying in a challenging financial environment. 

Editor's note: Responses were lightly edited for length and clarity.

Question: What has been your biggest challenge as Intermountain CFO?

Janie Wade: The challenges we're experiencing are a lot of the same challenges that most health systems are facing right now. The primary challenge has been the mismatch between inflation on the revenue and expense side. We serve a lot of communities that are heavily governmental in their payer mix, so the revenue inflation is not rising as fast as the expense inflation has over the last 18 to 24 months, and it's clearly here to stay. 

Q: It's no secret that many health systems have seen margins shrink amid labor challenges, declining inpatient volumes and record-high inflation rates. What is Intermountain's game plan for tackling these issues and reducing costs in 2023?

JW: We're focusing on simplicity, which we think drives a lot of benefits on the cost side of our operations. Reducing the administrative complexity that plagues not just our caregivers but also our patients, and makes it harder for them to seek care. That is one of our main focuses, in addition to service excellence so patients want to return for their care and caregiver engagement. Part of the labor shortage solution is to not lose caregivers, so we're really focused on retention and engagement with our providers. Those are our highest focuses this year. We're committed to delivering on those and continuing to provide high-quality, safe and affordable care.

We also have a program called iFlex, which is an internal staffing agency that started in our Utah region, and that model is being moved into the Colorado market as well. We have been doing automation for decades, but are really excited about some of the potential for ChatGPT that has really exploded. We see big potential there in terms of simplifying tasks for our caregivers so they can spend more time with patients and less time with documentation.

Q: What are some of your other top priorities as CFO this year?

JW: We are completing our integration process. We said we would take about two years to integrate and we're just past the one-year mark. We're continuing to integrate the two health systems. Intermountain has a strong operating company model, so we're rolling that out throughout the larger organization and standardizing clinical services across the care continuum. But our biggest focus is service excellence and caregiver engagement. Those are our two top priorities, and that comes all the way from the board level. 

Q: The healthcare sector has seen a significant uptick in hospital and health system M&As recently. What advice do you have for health systems considering merging with other large organizations?

JW: Culture drives everything. Hopefully, like we were, you're aligned culturally before you ever merge. We found that Intermountain and SCL Health were much more similar than different, so having that cultural fit going into the transaction is really important and making sure you're driving that culture through the new organization. You want to adopt the best practices between the two organizations, but you have to do that in a very decisive and quick manner. My biggest advice is not to ignore culture. A lesson learned from every merger ever is not to discount communication. If people understand what you're doing and why you're doing it, they're much more supportive of it. Those are the two biggest things. It's all about the people — how you're communicating with them and how you're making them feel. 

Q: Where are Intermountain's biggest opportunities for growth in the next three years?

JW: We are building a children's hospital in one of our Utah suburban markets and we're replacing a hospital in Wheat Ridge, Colorado. We're still doing traditional brick-and-mortar expansions, but our biggest opportunity for growth is our insurance plan, SelectHealth. It allows us to move into markets like Colorado, where we're going to be operating a plan in 2024 for Medicare Advantage and the individual exchange. We have a partnership in Colorado with UCHealth in a clinically integrated network, which is something we think will deliver a lot of value to the community in terms of value-based care in a way that's never been done in Colorado before. 

There's also tuck-in growth opportunities including ASCs, imaging centers and physician practice acquisitions. We don't have any large merger and acquisition targets on the horizon. It's primarily growth in our existing markets in the communities we already serve and bringing our quality of care, affordability and innovation into those communities with new providers and services. 

Q: How does Intermountain approach those tuck-in growth opportunities with ASCs as we increasingly see care move away from hospitals towards the outpatient setting?

JW: In some cases, it makes sense for ASCs to be wholly owned and in others it makes sense to partner with physicians in a joint venture. Sometimes we're not the experts at managing something and we want a partner that can help us manage operations and deliver the best care and service to our patients. It depends on the market and on where the expertise is. 

We definitely see a shift to outpatient, and I think we have almost hurdled off into the digital setting in the last few years. Outpatient is one thing, but we also need to do more care at home. We have one of the largest hospital-at-home programs in the country and have seen large growth in telehealth since the pandemic. For telehealth and at-home care, I think we'll start to see a big shift into the digital world with innovations like wearables. There's more technology coming, and the adoption of that is coming at a lightning pace. 

Q: What advice do you have for CFOs at other health systems who are finding it difficult to boost their margins amid widespread financial challenges? Where has Intermountain found the most success?

JW: Continue to innovate and simplify. Utilize technology to make things easier for your caregivers and free up their capacity and make things easier for patients to access your services. As consumers, I think we have all found that it is not always easy to get into a health system, so make it easy for your community to access your services and make it easier for your caregivers to deliver that care.

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