NSLIJ - Source: Long Island Business News
North Shore-LIJ Creates Health Insurance Network
4/3/11 10:14 AM
North Shore-LIJ Creates Health Insurance Network Source: Long Island Business News November 24, 2010
By: Claude Solnik The North Shore-Long Island Jewish Health System is rolling out insurance plans to its employees that use the system itself as the basic provider network in a possible medical model for plans rolled out to other organizations. The Great Neck-based system, which employs nearly 40,000, has long offered plans based on standard health insurance networks. But the area’s biggest employer is now rolling out options with Empire BlueCross BlueShield and Aetna to its employees, offering better deals if they use only North Shore-LIJ and affiliated providers, raising monopoly and privacy concerns among observers. The lower costs are intended to encourage North Shore-LIJ employees to get health care from the system, boosting its business and, potentially, making it easier to monitor and manage care. “We’re hoping we’ll be able to demonstrate the way we manage our employees that this would be a good opportunity to bring a product to the market,” said Howard Gold, North Shore-LIJ’s vice president for managed care and business development. “We hope that by managing our employees in our defined network, this would be a good prototype for the marketplace.” North Shore-LIJ is offering the new plan as an option in addition to its Open Access Buy-Up plan, the more expensive insurance. The new plan, known as High Value Select, lets employees obtain care within the North Shore-LIJ network with no co-insurance, low co-payments and no deductibles. But observers worry North Shore-LIJ may not simply be trying to improve employees’ care, but to earn more by steering workers to its doctors and services. Ilene Corina, president of Wantagh-based patient advocacy group PULSE of NY, said there’s the risk of a monopoly if providers create insurance networks incentivizing their employees not to go elsewhere. “If they’re doing it for financial gain only, I have a problem,” Corina said. “If they feel they can monitor a patient better and get better outcomes, that’s different.” Brian Currie, CEO of the 11-hospital Long Island Health Network, which includes the Catholic Health Services of Long Island, said he isn’t sure “this plan will reduce health care costs for consumers” simply by shifting care to North Shore-LIJ. Gold said in addition to financial benefits to the system, North Shore-LIJ hopes there will be medical benefits, since the system could “monitor and benchmark performance better and make it a higher quality with more affordability.” He said doctors typically operate in a fragmented environment, while North Shore-LIJ could coordinate care provided within its network, improving follow up, communication and better promoting prevention. Although creating insurance plans around systems is unheard of in our area, the Geisinger Health System in Pennsylvania has rolled out its network as the basis for an insurance plan for its employees. Partners Healthcare, a provider network in Boston, has begun to offer its providers as a network for insurers. The Advocate Health System in Illinois is rolling out plans in which its employees save by staying within their network. North Shore-LIJ views this model as a way to create a partnership with health care and financial benefits rather than an adversarial relationship between provider and payer. “You don’t have to be an insurer to do this, but you need an insurance partner,” Gold said. “We think this will be very interesting.” North Shore-LIJ employs about 42,000, but about 15,000 are covered through union plans. About 27,000 people and their families are eligible for the new plans. Gold said North Shore-LIJ will track patients, look at claims information and have teams of doctors review big cases and case managers make sure employees get timely care. Gold said North Shore-LIJ also will ask employees to get involved in wellness programs and take nonsmoking pledges. But Corina said the provider needs to be careful it doesn’t violate its employee privacy rights. “They have the privacy issue. An employee with AIDS is being treated by their doctors and hospital,” Corina said. “What if the patient has something they don’t want their hospital or employees to know about?” Since hospitals routinely manage privacy issues when treating employees, these plans could rely on privacy policies already in place. The final verdict on this approach, Gold said, will be whether patients benefit, potentially prompting bigger payments from insurers in the form of performance incentives for doctors, hospitals and systems. He said North Shore-LIJ hopes readmission rates, length of stay and infection rates will drop, while increasing well-baby care, vaccination rates and primary care visits. “Are we hitting national benchmarks?” Gold said. “We will apply the same standards of performance with our full-time and http://www.northshorelij.com/NSLIJ/North+Shore+LIJ+Creates+Health+Insurance+Network
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NSLIJ - Source: Long Island Business News
North Shore-LIJ Creates Health Insurance Network
4/3/11 10:14 AM
community doctors.” The first challenge, though, will be getting employees to sign on to the plan, with coverage starting in January. “It’s open enrollment now. We’ll see if they sign up,” Gold said. “I believe they will. It’s substantially less expensive. I expect that will happen.”
Last Update November 29, 2010
http://www.northshorelij.com/NSLIJ/North+Shore+LIJ+Creates+Health+Insurance+Network
© Copyright North Shore-LIJ Health System 2010.
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