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
Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with 48,000 employees working across seven hospitals, more than 400 outpatient practices, more than 600 research and clinical labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time—discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.
Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes approximately 9,000 primary and specialty care physicians and 11 free-standing joint-venture centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida. Hospitals within the System are consistently ranked by Newsweek’s® “The World’s Best Smart Hospitals, Best in State Hospitals, World Best Hospitals and Best Specialty Hospitals” and by U.S. News & World Report's® “Best Hospitals” and “Best Children’s Hospitals.” The Mount Sinai Hospital is on the U.S. News & World Report® “Best Hospitals” Honor Roll for 2024-2025.
For more information, visit https://www.mountsinai.org or find Mount Sinai on Facebook, Instagram, LinkedIn, X, and YouTube.