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 New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 14 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Diabetes/Endocrinology, Gastroenterology/GI Surgery, Geriatrics, Gynecology, Nephrology, Neurology/Neurosurgery, and Orthopedics in the 2019-2020 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 12th nationally for Ophthalmology, Mount Sinai St. Lukes and Mount Sinai West are ranked 23rd nationally for Nephrology and 25th for Diabetes/Endocrinology, and Mount Sinai South Nassau is ranked 35th nationally for Urology. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and Mount Sinai South Nassau are ranked regionally.