As Dallas-based Tenet Healthcare aims to dramatically turn around its financial outlook by refocusing attention from hospitals to ambulatory care, there is uncertainty about what could come next for its profitable subsidiary Conifer Health Solutions, Frisco’s second largest employer.

Conifer bills itself as a revenue cycle management and patient communications firm. What that means is it helps hospitals connect with patients at the front end of care, to properly code those medical visits, and ultimately, to collect reimbursements for the care that was provided.

Since Conifer launched in 2008, business has grown eightfold to include more than 800 health care facilities. Conifer generates about eight percent of Tenet's consolidated net operating revenues, and last year logged $1.6 billion in revenue.

The corporate headquarters in Frisco is located in two nondescript office buildings at the intersection of Dallas and Warren parkways. It’s home to the administrative leads, a training center, and just under a tenth of Conifer’s 14,000-person nationwide workforce.

The company has generally been touted a success for Tenet, which in recent years has struggled with financial losses -- in part due to multimillion dollar legal payouts -- mounting debt and leadership shakeups.

Last December Tenet said it was looking to sell Conifer, a company it jointly owns with Colorado-based Catholic Health Initiatives. The news came as Tenet, the third-largest investor-owned hospital company, aggressively pressed forward with a $250 million cost-reduction plan that involves shedding underperforming hospitals, shifting its focus to outpatient care and cutting costs.

The shift to ambulatory care can help Tenet "to be where the patient is," chief executive, Ronald Rittenmeyer, told investors Tuesday as the company recapped its 2017 financial performance.

Plus, the revenue generated from a Conifer sale could help pay down debt. By some estimates, Conifer could sell for $2 billion. In the meantime, it is stuck in the middle as the current owner refocuses.

Since 2015, Tenet has shed nearly 20 hospitals in several states. That includes ending a two-year old partnership in which it jointly operated five North Texas hospitals with the large nonprofit health system, Baylor Scott and White Health.

These divestments could have an impact on the upwards of 7,000 patient access representatives that Conifer has deployed at hospitals across the U.S. Especially because, a big bulk of Conifer’s business -- about 74 percent -- comes from Tenet and Catholic Health owned facilities.

In 2015, Conifer announced an expansion of its contract with 92 Catholic Health hospitals, an agreement that runs through 2032. Yet, revenue dipped two percent in fourth quarter, down to $394 million, a loss attributed to Tenet hospital divestitures. Rittenmeyer noted that new owners of divested Tenet hospitals don’t always enter contracts with Conifer, a concern as more facilities are shed.

Hospitals across the country have been outsourcing debt collection and revenue cycle management tasks, but Conifer’s third-party business has lagged. The lack of “client diversification” can make it harder for the company to be sold, said Brian Tanquilut, an analyst that follows Tenet for Jefferies in a report issued earlier this week.

Still, Conifer's earnings during the fourth quarter were $13 million higher than expected, and the company a valuable asset, Rittenmeyer said. He said he's "very pleased" with the amount of interest from potential buyers, and said Conifer will continue to pursue new business as the quest continues.

Conifer, which now has local offices in about 135 markets in the U.S., is also looking to consolidate and eliminate operations in areas where the service is not needed , chief executive, Stephen Mooney, told investors Tuesday.

Clarification, March 1, 10:20am: A previous version of this article described Conifer as being spun off from Tenet. While Conifer is a separate entity, it is still owned by Tenet.