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Mergesurance Mania

Mergesurance Mania

Mergersurance Mania

Insurance mergers aka Mergersurance Mania continues at a steady pace with April 2016 Florida’s approval of Anthem Blue Cross and CIGNA merger.  This is one month after Florida approved the Aetna and Humana merger.  Investors have given their blessings to be sure while 10 States have also given approval. The Anthem Cigna $54 billion merger leaves only three national major providers of health care. Worries remain about the potential effect on consumers and the rising cost of health care.Hospital Mergers

Health Insurers consolidation argument are that they need to be able to  merge in order to absorb added costs and blunted profit margins under the Affordable Care Act.  Additionally, medical groups and hospitals groups have merged themselves rapidly giving them negotiation cost controls. This has traditionally been trending in smaller regional markets but are now also felt in major US Cities.

Evidence indeed is pointing to expected large insurance increases due to overwhelming market domination by hospitals. While Doctors and AMA are rightfully concerned about Insurer mergers the vast majority are now working for a Hospital System or Medical IPA.

Without public outcry there seems to be lax Regulator oversight and the  arms race should not come as a surprise.  On the local level we have yet to see a recent example of hospital merger that was curtailed.

This goes well beyond political partisanship. In a tight Presidential race it is important to understand that whether or not one supports a Single Payer we all suffer.  This is bad for consumers, providers and tax payer all around.  In an Oligopoly health care system with lack of competition the U.S. tax payers are also stuck with inflated costs.

Past Articles:

Breaking: Maimonides North Shore LIJ Partnership Aug 2015
Montefiore Buying Sound Shore Hospital  May 2013
 NYU Beth Israel Hospital Merger and ACO June 2012
HIP/GHI Merger Mar 2008

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Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership
Breaking News: NSLIJ, and Brooklyn’s Maimonides Announce Strategic Partnership on Wednesday. Both side shave been in talks since February.

Eventually North Shore-LIJ and Maimonides will fully integrate, “in a phased approach that will begin immediately,” the two jointly announced Wednesday. In the meantime, both institutions maintain their independence and separate governance structures. Lynam said there was no specific time frame for full integration.

Maimonides gets much-needed cash — tens of millions of dollars — for capital and operational investments. That will help it compete with Presbyterian-backed Methodist and Langone-backed Lutheran. North Shore-LIJ gets its first real foothold in #Brooklyn, one of the most competitive health care markets in the nation. But it does so without the commitment that a full-scale merger would entail. An affiliation agreement also protects North Shore-LIJ from unknown liabilities related to the Federation of Jewish Philanthropies, a malpractice insurer that covers Maimonides and several other hospitals

North Shore-LIJ  has made strategic partnerships and acquisitions before.  For North Shore-LIJ, the relationship means it has a hospital or hospitals in every borough as well as blanketing Westchester and Long Island.  North Shore-LIJ, the country’s 14th largest health care system, owns 19 hospitals. In the city that includes Lenox Hill Hospital in Manhattan, Staten Island University Hospital, and, in Queens, Forest Hills Hospital, Long Island Jewish Medical Center, Cohen Children’s Medical Center and Zucker Hillside Hospital, a behavioral health center.

They are also actively insuring members today in the Downstate NY area under the CareConnect NSLIJ holding company.  With important advantages under ACA and mindful of delivering value the insurance arm is priced affordably.  In fact they had lowered their rates 15-20% for 2015 and and industry low 3.3% for 2016.

For more information on 

See PR Announcement here
Related Posts: NSLIJ CareConnect adds WestMed
NSLIJ Adds Phelps Hospital
CareConnect NSLIJ
NYS 2016 Rates Approved
How Your Hospital Ranks

How Your Hospital Ranks

How Your Hospital Ranks CMS Hospital Rankings

With first new star rankings released yesterday by CMS (Center for Medicare & Medicaid Services) this will be a little easier for consumers.  The role of Government in medical transparency have long been touted as a qualitative and cost factor.   The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality.

The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:

•           How well nurses and doctors communicated with patients

•           How responsive hospital staff were to patient needs

•           How clean and quiet hospital environments were

•           How well patients were prepared for post-hospital settings

Only 251 hospitals–or 7 percent of those ranked–received a five-star rating under the new system, Kaiser Health News reported. The largest share of hospitals (40 percent) received three stars, including highly respected institutions such as Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. Only 3 percent of hospitals netted one star.

Consumers will now see 12 HCAHPS Star Ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures, plus a summary star rating that combines or rolls up all the HCAHPS Star Ratings. These star ratings will be updated each quarter.  Also, the Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality.

For more information on yesterday’s announcement, please visit here: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-04-16.html

No More Surprises – NY Surprise Medical Bill Law

No More Surprises – NY Surprise Medical Bill Law

Emergency Bill HelpNo More Surprises – NY Surprise Medical Bill Law

Consumer complaints about receiving inadequate reimbursement from their insurers for medical services that they received outside of a provider network have been answered by New York’s “Emergency Medical Services and Surprise Bills” law. As of March 31, 2015, consumers will have protection from “surprise” medical bills for emergency medical services and certain out-of-network medical services.

The state of affairs today for small business plans offering both in and out of network is an exception with only 2 insurers in Downstate covering out of network at catastrophic high deductible levels.  For Individual Marketplace it is even more dire with NO OUT OF NETWORK coverage at all.

The Problem. This has been a pattern in recent years and posted in Out of Control Out of Network Charges (March 2012).  According to an investigation report commissioned by Governor Cuomo recognizing the unexpected out-of-network claim problem.  Officials say that this is now  “an overwhelming amount of consumer complaints.”   Some examples cited in the report An Unwelcome Surprise – “a neurosurgeon charged $159,000 for an emergency procedure for which Medicare would have paid only $8,493.”  Another example: ” a consumer went to an in-network hospital for gallbladder surgery with a participating surgeon. The consumer was not informed that a non-participating anesthesiologist would be used, and was stuck with a $1,800 bill. Providers are not currently required to disclose before they provide services whether they are in-network.” The average out-of-network radiology bill was 33 times what Medicare pays, officials say.

The blog post goes on to say “Today, 90% of SMB members have in network only benefits but the few remaining consumers are paying for eroding out of network benefits with little transparencies and necessary protection from new out of network billing practices.  The NY Dept of Financial services  is calling for providers in non-emergency situations to disclose whether or not all services are in-network, what out-of-network charges will be and how much insurers will cover.”

Balance Bill Protection.  The long awaited bill passed last April protects patients from out-of-network providers from “balance-billing” consumers for emergency care or when patients can’t choose their doctors. Balance-billing occurs when health workers who don’t accept a patient’s insurance try to collect the difference between their charge and the insurer’s reimbursement.

Provider Disclosure Requirements. Hospitals will now be required to disclose anticipated charges. Patients most often receive these surprise bills in emergency cases, when they can’t choose the doctors who treat them.  Its not unusual for a Provider to come into the picture who may read your tests or touch you thats not in network.  Under the new law all medical providers will have to notify patients before treatment if they don’t take their insurance. If not, patients will be required to pay only a regular co-pay as if the provider was in network.

Providers will need to provide patients with disclosures of the health plans with which they participate and the names of the providers that may be billing them. They are also required to disclose procedures to follow with the an independent dispute-resolution entity (IDRE) which will be the arbiter of disputes under the law  if a patient feels that a bill is inappropriate.

Network Adequacy. While the Affordable Care Act didn’t address surprise bills, the government has imposed network adequacy requirements that prevent health plans from having too few providers, which may reduce the number of cases where patients find themselves inadvertently out-of-network. New York will now require doctors and hospitals to disclose their network status before treatment in non-emergency procedures. Insurers will have to update online provider directories within 15 days of a change.

Prior to the Surprise Bill Law, these network adequacy rules only applied to health maintenance organizations (HMOs) and other “managed care” plans.   HMO’s normally have more Provider/Insurer responsibility shifting form the patient. As with most non-HMO plans, however, the responsibility rests with patient to make sure everything is pre-authorized and in network is possible.  Starting next month Health plans that are also based on more comprehensive PPO and EPO are also required to be certified as having provider networks that can meet the health needs of their members without having to rely on more expensive out-of network services.

A patient protection law is a welcome respite form the unfair unwelcome surprises out of one’s control. Common sense finally prevails!

Resource:

NYS – Protection from Surprise Bills and Emergency Services

 

 

NSLIJ CareConnect adds WestMed

NSLIJ CareConnect adds WestMed

NSLIJ CareConnect adds WestMed
CareConnect Logo 4CSM    +   WesMed joins NSLIJ CareConnect

WestMed Medical Group has now joined the North Shore LIJ’s insurance – CareConnect Network! This is not a purchase.  This partnership  expands their footprint and makes CareConnect a compelling  fit for individuals and groups located in Westchester. In addition, CareConnect has just announced CareConnect’s Network Expansion! Yale-New Haven Health and all their facilities are now in-network with CareConnect.  Tools are available to search for providers with updated expansion to be added shortly.

A combined Hospital Insurance system is an intriguing concept thats not all that new.  Pittsburgh’s UPMC has been delivering the same model in Western PA successfully. In NYS  an integrated medical approach is new on the other hand and challenging in an open  competitive loop.  A high quality smaller network that is priced affordably and can offer Patient Concierge like service may be what the market is asking for. They may also be in a better position to manage patient health and Preventative Medicine.   For Jan 2015, NSLIJ CareConnect will have a 20% reduction in most regions such as Westchester and NYC.   For new rates, benefits and provider listings click – CareConnect NSLIJ

For more information, please 

Press Release#

Award-Winning WESTMED Joins CareConnect!

We’re pleased to announce our continued network expansion with the addition of WESTMED Medical Group. With this practice, CareConnect members now have more access in Westchester County:

•  289 physicians in eleven office locations
•  On-site laboratory and radiology services
•  Four urgent care centers
•  Three NCQA recognized programs including the patient-centered medical home and diabetes
Stay tuned as we continue to add access for your groups around the CareConnect service area

Interfaith Hospital Planning Shutdown

Interfaith Hospital Planning Shutdown

Bedford Stuyvescent Hospital Closing

Interfaith Hospital Planning Shutdown. The Bedford Stuyvescent Hospital entered bankruptcy court this week to approve its closing and send layoff warning notices to its 1,544 employees. Pending court and state approval, on Aug. 12 the hospital will end inpatient admissions and divert ambulances to other hospitals. Elective surgeries will end Aug. 19, the emergency department will shut Sept. 11, and all patients will be transferred from the hospital by Sept. 12. Outpatient programs will end Oct. 12 and detoxification and rehabilitation programs Nov. 11.

The bankruptcy court hearing for Interfaith is August 15. The hospital services 175,000 people  with closest hospital in this predominantly minority community is about two and a half miles away.

The threatened closing of another Brooklyn hospital, Long Island College Hospital in Cobble Hill, has become an issue in the mayoral campaign. The  506-bed  hospital — which it said to be losing $4 million was taken over by Downstate   in 2011, inheriting a $170 million debt. The Hospital’s location is very sought after and will likely be purchased by developers.  Developers are coveting LICH’s $1 billion in prime brownstone Brooklyn waterfront buildings.

See our original blog story Interfaith Hospital Files Bankruptcy, Dec 7, 2012.