by Admin. | Jun 12, 2012 | Health Care Reform, Hospitals, PPACA
Accountable Care Organization
NYU Beth Israel Hospital Merger and ACO
Accountable Care Organization
As reported in NYT last week – New York Hospitals Look to Combine, Forming a Giant “The proposed merger would bring together NYU Langone Medical Center, a highly specialized academic medical center, and Continuum Health Partners, a network of several community-oriented hospitals, including Beth Israel and the two St. Luke’s-Roosevelt campuses.”
Anticipating changes in the way health care is paid for and delivered abound. WIth new Health Care Reform law the traditional fee-for-service model is being sacked in favor of patient care coordination. The consolidations by hospitals are needed in order to deliver the scales build on the ACO model of using independent providers/facilities.
Accountable Care Organization (ACO) – These organizations coordinate patient care and provide the full range of health care services for patients. The health reform law provides incentives for providers who join together to form such organizations and who agree to be accountable for the quality, cost, and overall care of Medicare beneficiaries who are enrolled in the traditional fee-for-service program who are assigned to the ACO.
The fee-for-service system has evidentially driven costs by incentivizing volumes of added procedures. The ACO model is built on par excellence hospitals such as Mayo Clinic where there is team of providers are financially incentivized for patient care coordination outcomes and high quality of care. The ACO’s payment would be tied to achieving goals that improve health care and save money. Members of the ACO would divvy up that payment. Today’s payment system, investments in providing better care are doubly penalized. If a hospital hires a nurse to follow up with patients after they are discharged in order to reduce readmissions — for example, to help patients with diabetes improve blood sugar control — it must pay for the nurse, which is typically not reimbursed by insurance companies or Medicare, and it loses revenue by preventing the readmission.
Congress included ACOs in the health care law as a way to rein in Medicare spending. That federal program pays for health care for people 65 and older and the disabled. The federal government estimates ACOs could save the Medicare program up to $940 million over four years. Medicare recently began testing this system with 32 pilot ACOs in 18 states, including one in the New York City area – Bronx Accountable Healthcare Network.
Some have pointed to ACO Model just as a pro-merger supporting argument with the FTC. These significant mergers create market dominance and therefore limit competition and drive up health care dollars. And yet Hospitals operate on thin profit margins and cannot afford to lose market share therein lies is the conundrum.
Addendum news: July 18, 2012 – Aetna and Hunterdon HealthCare Partners Forge New Accountable Care Relationship
by Admin. | Apr 23, 2010 | healthcare, Hospitals, NY News
Just a heads up on a topic that will be all too familiar going forward. We see this as a trend and not the exception. As hospital systems have consolidated in reaction to negative market condition and increasing costs of doing business. But size is better when it comes to negotiating with insurers. We are seeing profitable hospitals asking for 15% rate increase form prior years. They can do this because insurer network marketability is on the quality and size of network.
Current News:
Aetna: Effective 4/5/2010, Beth Israel Medical Center – Petrie Division, Beth Israel Medical Center – Kings Highway Division; Long Island College Hospital; New York Eye & Ear Infirmary; and St. Luke’s Roosevelt Hospital Center – Roosevelt Division, and St. Luke’s Roosevelt Hospital Center – St. Luke’s Division (the “Continuum Hospitals”) were terminated from the Metro NY Aetna network. The hospitals will remain participating and will be accepting In Network Rates until the end of the cooling off period on 6/5/2010.
Continuum had almost lost United/Oxford Health Net in march and Empire or Wellpoint last Spring.
Empire Effective 4/1/10 has lost Stellaris Health Network in Westchester. Those hospitals include Phelps Memorial, Lawrence Hosp, White Plains Hosp, and Northern Westchester Hosp. They were asking for double digit increases for each year of a mutli-year contract, which would have had to be passed on to our members in the form of higher premiums. Our Empire clients will be covered in those facilities for emergencies, as well as services that have already been pre-authorized and approved.
A released Empire Fact Sheet of the contract termination is available
While this happened somewhat in prior years things usually were worked out at 11th hour after a cooling of period. Whats troubling now is that there is little common ground to stand on. We believe in the short term they will get reworked as both Mammoth Corp need each other but this will be a serious concern worth watching.
by Admin. | Jan 27, 2010 | healthcare
http://www.crainsnewyork.com/article/20100126/FREE/100129916#
“Facing crushing cash flow crunch it seeks deal that could keep system from returning to bankruptcy court; Continuum Health Partners says it has entered discussions.”
Hospitals are obligated to accept all patients regardless if insured and yet face the free market alone. Is it any wonder Lenox Hill is the lone independent hospital left….for now.
by Admin. | Feb 20, 2024 | group health insurance, Hospitals, NY News, Small Business Group Health, United Healthcare
Mount Sinai, UnitedHealthcare dispute terminating contract March 1, 2024 . What Oxford/United members need to know.
by Admin. | Aug 31, 2023 | group health insurance, Health Care Reform, healthcare, individual health insurance, latest health insurance news, NY News, Small Business Group Health
Earlier today, the long-awaited NYS Dept of Financial Services approved 2024 health insurance rate requests. And it was worth it with small groups stabilized. Small group rates increased by 7.4% and 12.4% for individuals. Oxford/Unitedhealthcare, notably, got only a 4.7% rate increase approval for next year
by Admin. | Mar 15, 2023 | AI, healthcare, Technology
Artificial intelligence can help spot early signs of cancer in chest x-rays. AI tool identified abnormal chest X-rays with a 99% sensitivity.
by Admin. | Nov 22, 2022 | Health Care Reform, healthcare, HR, HSA, Tax
To prepare for 2023 open enrollment, health plan sponsors should be aware of the legal changes affecting the design and administration of their plans for plan years beginning on or after Jan.
by Admin. | Nov 13, 2022
2023 NY Small Group Health Plans-See latest plans for SMB offering plans w/national ranked Providers.Call 855-667-4621 info@medicalsoluionscorp.com
by Admin. | Nov 13, 2022
2023 Oxford Metro Network NY-For 2023 the network has expanded 15% in NY and added the NJ network last year. In 2022 most Metro plans stayed flat and for 2023 increasing single digits. Best oxford value on the market.