ProMedica’s next venture will take the Toledo-based health system far away from its current Midwest footprint as the nonprofit’s leaders consider getting involved with as many as a dozen projects halfway around the world in China.

Officials said ProMedica’s efforts in China would focus on consulting services for hospital leaders there and investors looking at health care-related projects. 

President and chief executive officer Randy Oostra, citing yet-to-be-signed agreements, did not identify specific clients, but described one as “a sister relationship with a large women’s and children’s hospital,” as well as academic, clinical, and management consulting opprtunities. 

“When we went to China what we were impressed by was the Chinese medical community,” Mr. Oostra said. “They are very open to work with American firms.” 

Opportunities are open-ended. One partner showed ProMedica officials a plot of land and asked them to build a hospital there. 

“It’s their capital, and we’ve been working through that,” Mr. Oostra said. “Does that mean we’re going to consult? We’re going to run it? We’re going manage it? We’re not quite sure, but we’re talking about it.”

The ventures are another example of ProMedica’s ever-expanding reach. Last week the health system announced it and real estate investment trust Welltower Inc. made a $3.3 billion bid to acquire eldercare firm HCR ManorCare Inc.

Though final details continue to develop, the acquisition would likely put ProMedica operations in more than two dozen states. ProMedica currently operates 13 hospitals, seven urgent care sites, four ambulatory surgery centers, and more than 300 other sites in northwest Ohio and southern Michigan.

ProMedica’s discussions in China began two years ago, said Kathleen Krueger, senior vice president of integration and president of ProMedica’s innovative business solutions group.

Since then, a small team of ProMedica executives, including Mr. Oostra, have traveled to tour hospitals in Beijing, Shanghai, Shenzhen, and Chengdu. 

“The fact is that you jump on an airplane in Detroit and you can be in Beijing fairly easily,” Mr. Oostra said. “A lot of their small cities have 8 million people, like the size of Ohio, and so there are opportunities there.”

In addition to what Mr. Oostra calls “global” opportunities for ProMedica’s physicians and the system’s affiliation with the University of Toledo College of Medicine and Life Sciences, the former Medical College of Ohio, the deals are financially beneficial. 

“And we think we’re going to make a profit out of it,” he said. “We’re doing this to make money and we think there is a great opportunity to make some money there.” He cited shrinking revenues in areas such as Medicaid reimbursement that force non-profit health systems to look elsewhere. 

Ms. Krueger declined to give a specific dollar amount related to any deals in the works. Mr. Oostra and Ms. Krueger said investing ProMedica capital in China is not planned at this time.

Paul Zito, vice president of international development for the Regional Growth Partnership, called ProMedica’s plans “a wise move” that shows the health system is willing to innovate. Mr. Zito, who works to encourage foreign investment in northwest Ohio and helps local companies expand abroad, said he hasn’t consulted with ProMedica about its China plans. 

“It shows that they are a competitor and that they want to innovate and be strong, which is fantastic for any company,” he said. 

China is in the middle of a health-care reform, prompted in part by a government push to improve basic medical services and boost private investment, according to a 2015 report by the consulting group Deloitte.

That creates opportunity for small but growing private investment in a country where 90 percent of health services are provided by public hospitals, according to the report. Among the opportunities: premium and specialty hospitals. The Deloitte report notes that a large share of private hospitals built in the early 2000s were for specialties such as obstetrics and gynecology, cosmetic surgery, and dentistry. 

Specialty centers such as ProMedica’s diabetes and neurosciences centers, are of interest to Chinese firms, Ms. Krueger said.

“Those are the types of services they would like to grow over there,” she said. “That’s one of the great points of ProMedica: clinical and operational expertise.”

That includes helping establish a greater continuum of care with more outpatient services outside a traditional hospital, she said. Other potential areas include robotic surgery and enhancing employee engagement at these Chinese facilities.

This summer ProMedica will welcome Chinese administrators and physicians for training, Mr. Ooostra said.

Mr. Zito said American companies must weigh the risks perceived with Chinese dealings against the growing opportunities there. Among those: intellectual property risks, corruption, and difficulty getting money in and out of China.

“About half of the U.S. companies that I encounter , to be honest, see China as too risky and they focus on other markets around the world,” he said. “Others who are well-established in the export markets of Europe, Canada, and Latin America are seeing if they are not strong in China, they might lose their position in the global market.”

Because ProMedica is not planning to invest its own money in China, Ms. Krueger said the ventures they are pursuing are much less risky. 

ProMedica is not alone among health systems in looking outside the United States. In a recent Wall Street Journal article about expansion into China, ProMedica was listed along with systems such as Steward Health Care System of Boston, the Cleveland Clinic, and the University of Pittsburgh Medical Center. 

China’s health-care market, Mr. Zito said, is in desperate need of “everything,” including surgical and diagnostic equipment, other health care consumer goods, and the human expertise to go with them. 

“There is a tremendous opportunity for [foreign] companies in China,” Mr. Zito said.

Contact Lauren Lindstrom at llindstrom@theblade.com, 419-724-6154, or on Twitter @lelindstrom.

First Published April 29, 2018, 4:49 a.m.