Humana and Mount Sinai Health Partners Create Improved Care Model
Through an arrangement between Humana Inc. (NYSE: HUM) and Mount Sinai Health Partners (MSHP), Humana Medicare Advantage members now have access to the health care providers of MSHP, which includes the clinically integrated network made up of Mount Sinai’s hospitals, the Icahn School of Medicine at Mount Sinai’s full-time faculty, and a group of independent practices.
This value-based care model is aimed at creating healthier outcomes and improving care collaboration, while reducing health care costs for Humana Medicare Advantage members.
Value-based care is a growing national trend representing a shift away from the historic health care model that focused on treating individual health events. Value-based care aligns all players in the health care system to focus on a person’s overall health and long-term well-being.
“When physicians, health systems, and health plans work together to align efforts and incentives, patient outcomes improve,” said Niyum Gandhi, chief population health officer for the Mount Sinai Health System. “Our strategy is to transform from a traditional fee-for-service model to a population health model — and partnerships like this one with Humana help us move in this direction by aligning all players in the health care system to focus on a population’s overall health and long-term well-being.”
The agreement includes value-based incentives tied to performance improvement and quality outcomes, emphasizing standard measures defined by the National Committee for Quality Assurance (NCQA) Healthcare Effectiveness Data and Information Set (HEDIS), including breast cancer screening, colorectal cancer screening and comprehensive diabetes care. The goal, according to Humana Medicare Regional President Alexander Clague, is to place primary care physicians at the center of the health care system.
“Primary care physicians are integral to creating a more effective health care system,” Clague said. “Value-based care creates a framework that allows primary care physicians to spend more time with patients, arms them with the tools they need to truly manage their patients’ health, and supports the health care system to be more responsive to the people it serves.”
Nationally, Humana has nearly 30 years of accountable care experience, including approximately 1.7 million individual Medicare Advantage and 200,000 commercial members, cared for by 47,800 primary care providers in more than 900 value-based payment relationships across 43 states and Puerto Rico. Currently, approximately 61 percent of Humana individual Medicare Advantage members are in value-based payment relationships. Humana’s goal is to have 75 percent of individual Medicare Advantage members in value-based payment models by 2017. For more information, visit humana.com/accountable-care or www.humana.com/valuebasedcare.
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."