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Spotlight: Healthfirst's unique approach to Value-Based Insurance Design

Analysis  |  By Laura Beerman  
   June 06, 2023

The payer is one of only two Medicare Advantage plans focused solely on social drivers of health in its CMS model.

As other stakeholders search for a business case to invest in social drivers of health, Healthfirst has gone all in.

Healthfirst is one of New York's largest not-for-profit health insurance companies, serving more than 1.8 million members. In an exclusive interview, SVP of Medicare Jen Cohen-Smith describes Healthfirst's VBID choices. This coverage is part of Payer Week—five days of in-depth coverage spotlighting the significant roles and contributions of health insurers.

Three business model differentiators

Cohen-Smith identifies three factors that made choosing social drivers easy:

  1. A hyperlocal approach;
  2. Already strong chronic disease management programs; and
  3. High member retention.

Healthfirst hires people who live, work, and play in the communities it serves (New York City, Long Island, and Westchester, Rockland, Sullivan, and Orange counties). Cohen-Smith reports that the plan also has the largest field sales team in the area.

These tight relationships include providers and members.

Healthfirst is sponsored by downstate New York's leading hospital systems and, the plan reports, has been a pioneer of the value-based care model for nearly 30 years. Its close hospital relationships have generated strong outcomes—making it possible for the plan to choose SDOH over chronic disease for its VBID model focus. (For VBID program details, see HealthLeaders' companion article)

Member retention is another Healthfirst advantage. Healthfirst has members in Medicaid, Medicare Advantage (MA), Long-Term Care, Qualified Health, Essential, and individual and small group plans. It also has a large dual-eligible population.

"Our Healthfirst members tend to stay with us for a very long time," says Cohen-Smith. "This gives us exceptional insight into what people of New York need. This not only fits with our mission but helps members see the value of our benefits over time and how to access them. We take good care of them."

Partnering, listening, pivoting

These differentiators connect to Healthfirst's most significant VBID learnings so far:

  1. Having the right partners (providers, vendors, operational structures) to deliver an innovative program that is easy for members to understand.
  2. Listening to members—before, during, and after VBID model launch.

The right partners ties back to Healthfirst's hyperlocal approach.

And while many stakeholders stress member feedback, you can hear its importance in Cohen-Smith's voice: the value and impact of three years of VBID process improvement.

"Having our ear to the ground has been critical," she says, stressing again how a hyperlocal approach allowed Healthfirst to adjust communications and education about VBID benefits.

Expansion and leverage: The benefits of being nimble

Healthfirst's initial VBID focus was an OTC Plus Card. Eligible members can use the card at neighborhood pharmacies, grocers and other businesses to pay for everyday expenses like healthy foods and over-the-counter items.

"The heathy foods program is especially challenging in New York City because most grocery stores don't belong to large chains; they're the small local bodegas on the corner."

The ability to be nimble helped Healthfirst expand OTC Plus to help with utilities and now internet access.

Healthfirst added the latter by keeping its ear to the ground more broadly. After New York introduced a program that made internet more affordable statewide, Healthfirst added the benefit to its OTC Plus Card.

"It was a great time to lean into digital access, given the growth of telehealth, and increased loneliness during and after the pandemic," says Cohen-Smith. "Because we're a regional plan, we could act quickly. Healthfirst was the first plan in the state to offer the benefit and others have followed."

Healthfirst is one of only two MA plans that have chosen SDOH as their focus for the CMS VBID model. Cohen-Smith acknowledges that demonstrating outcomes remains challenging, even with Healthfirst's advantages.

"Two and a half years into VBID, it's still hard to show that the value we thought we'd get is in fact happening. SDOH results just take longer."

Laura Beerman is a contributing writer for HealthLeaders.


Only a few of CMS payment model programs have included Medicare Advantage. Value-Based Insurance Design is one of them.

Healthfirst joined VBID in 2021, with a sole focus on social drivers of health.

The plan's SVP of Medicare details its VBID differentiators and key lessons learned.

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