CHP: NY Health Exchange and ACO Updates

NY Health Exchange Gears Up For LaunchCrain's Health Pulse April 22, 2013

The New York Health Benefit Exchange is in the final stretch of preparations for October enrollment and a January launch. New York is among 19 states running their own exchanges, and is not affected by the recent decision by the Obama administration to delay until 2015 the Small Business Health Options, or SHOP program, for states that have opted for the federal government to run their exchanges. (The New York exchange released fact sheets on SHOP last week, which are online here<>.) "We are proceeding full steam ahead for year one," said Danielle Holahan, deputy director of NYHBE, speaking at the April 18 meeting of the Hudson Valley chapter of the Healthcare Financial Management Association. Health plans had until April 15 to let the state know if they planned to participate in the insurance marketplace. Ms. Holahan would not disclose which insurers responded. "We are very pleased with the applications and think there will be robust choices," she said. The plans have until April 30 to file premium rates with the state. The exchange is currently reviewing applications for navigators and expects to award contracts this summer. It released a Request for Applications in February for the In-Person Assistor and Navigator Program, which will provide in-person enrollment assistance to individuals, families, and small businesses and their employees who apply for insurance through the exchange. Ms. Holahan said that premium costs should fall for both individuals and small businesses buying insurance through the exchange. But hospitals expressed concern about the impact of the exchange on their bottom lines. Kevin Dahill, president of the Suburban Hospital Alliance and NorMet, told the audience at last week's HFMA meeting that he feared some plans offered on the exchange would have low premiums but high out-of-pocket costs that patients may not pay. "That puts our hospitals in the position of being a collection agency, and I'm very concerned about that," he said.

ACOs Seen as Paradigm Shift Crain's Health Pulse April 22, 2013

New York's health industry is showing "considerable enthusiasm" for accountable care, according to an April 11 report from the United Health Fund. But adopting that model will require "changes in culture and frame of reference, major improvements in performance, and a series of new capacities and new skills for population health management," the UHF warned. Accountable care means providers are responsible for the health of an entire population, "not just those who use health care services," and that doctors and hospitals will have to view visits, admissions, tests and procedures "as costs rather than sources of revenue." The 32-page report offers an analysis of issues to be addressed, as well as a snapshot of where the state's providers currently stand in terms of what types of accountable-care organizations they have started, what savings they expect and what costs they likely will incur. The analysis includes detailed profiles of 12 of the 17 Medicare ACOs now operating in New York, and lays out challenges ahead. The report is here<>