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NY Hospital Joins Payer Fray

Rene Letourneau, for HealthLeaders Media, August 5, 2013

"It was proof that the idea of a self-contained network could work from a quality, coordination, and financial point of view," he says. 

In late 2012, North Shore LIJ decided to apply for a license to sell CareConnect as a commercial insurance product after being encouraged by the level of interest area businesses and unions showed in the health plan.

"When the Affordable Care Act passed and Obamacare became law, we decided to launch our own insurance product around these ideas that have been proven by our employees," Gold says. "We realized the days of fee-for-service reimbursement are numbered. An alternative reimbursement model around shared risk was one way to promote quality. When the ACA became law, we realized we could jump out ahead of this and get there first and prove it can be done."

"The stars aligned," he notes of the fortuitous timing.

North Shore LIJ expects to enroll between 5,000 and 15,000 members in the first year. Alan Murray, vice president of managed care, says the system is deliberately keeping the plan small to start.

"We are trying to be very careful and ease our way into this," he says. "Ultimately, the experience of each member is what comes first. We want to change the way healthcare is delivered from the insurance and provider sides, to make it connected."

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