Empire BlueCross BlueShield, Mount Sinai Collaboration to Improve Care and Lower Healthcare Costs
Empire BlueCross BlueShield and the Mount Sinai Health System have established an accountable care arrangement to improve quality, enhance personal health care, and reduce medical costs through collaboration and increased efficiency.
Empire BlueCross BlueShield and the Mount Sinai Health System have established an accountable care arrangement to improve quality, enhance personal health care, and reduce medical costs through collaboration and increased efficiency. Empire is the largest health insurer in New York, and Mount Sinai is one of the largest academic medical centers nationally, with more than 6,600 physicians, seven hospitals, and the Icahn School of Medicine at Mount Sinai.
The goal of the agreement, which took effect on January 1, 2015, is to guide Empire’s 48,000 Commercial and Medicare members who are attributed to the Mount Sinai Health System, improve their health and maintain healthy habits through coordinated care that aims to prevent duplicative services, unnecessary emergency room visits, and preventable hospital admissions. Central to Empire’s Accountable Care Organization (ACO) contracting approach is an Enhanced Personal Health Care strategy that requires the development of individualized care plans for members with chronic or complex conditions. Accountable Care Organizations (ACOs) are characterized by a payment and care delivery model that seeks to link provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of individuals.
“It is a good partnership when provider and payer are both focused on improving health outcomes, streamlining care models, and driving down costs, and we are pleased to work with Empire BlueCross BlueShield to bring our expertise in primary care and population health management to bear in attaining these goals,” said Kenneth L. Davis, Chief Executive Officer and President, Mount Sinai Health System.
Under the new accountable care arrangement, the Mount Sinai Health System is responsible for managing all aspects of the patient’s health--coordinating medical care, closely monitoring the patient between visits, and ensuring necessary follow up care is received. Empire will provide additional compensation with reductions in medical cost and achievement of quality goals set under this agreement. Among the anticipated benefits are better health, reduction in duplicative testing, less absenteeism, lower costs, higher worker productivity, and more efficient use of provider resources.
“We are very excited about this closer collaboration with Mount Sinai Health System, which we expect will improve the health of our members and make health care more affordable,” said Brian Griffin, President and CEO, Empire BlueCross BlueShield.” “We are committed to developing new collaborative models in line with the “Triple Aim” goal – achieving better population health, providing higher quality of treatment and reducing the costs of care.”
Both organizations will collect and analyze data on quality, costs, and utilization which will enable them to identify opportunities to improve care and keep care affordable for patients and employers in New York.
About Empire BlueCross BlueShield
Serving New Yorkers for 80 years, Empire BlueCross BlueShield is the largest health insurer in New York supporting nearly five million members and more than 38,000 business, union and small employers in New York. Empire BlueCross BlueShield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at www.empireblue.com. Also, follow us on Twitter at www.twitter.com/healthjoinin or @empirebcbs and Facebook at www.facebook.com/HealthJoinIn, or visit our YouTube channel at www.youtube.com/healthjoinin
About the Mount Sinai Health System
The Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 7,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is in the "Honor Roll" of best hospitals in America, ranked No. 15 nationally in the 2016-2017 "Best Hospitals" issue of U.S. News & World Report. The Mount Sinai Hospital is also ranked as one of the nation's top 20 hospitals in Geriatrics, Gastroenterology/GI Surgery, Cardiology/Heart Surgery, Diabetes/Endocrinology, Nephrology, Neurology/Neurosurgery, and Ear, Nose & Throat, and is in the top 50 in four other specialties. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 10 nationally for Ophthalmology, while Mount Sinai Beth Israel, Mount Sinai St. Luke's, and Mount Sinai West are ranked regionally. Mount Sinai's Kravis Children's Hospital is ranked in seven out of ten pediatric specialties by U.S. News & World Report in "Best Children's Hospitals."