For Catholic Health and Empire, a new partnership on Long Island

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By Dan Sears

Catholic Health, the health system headquartered in Rockville Centre, and Empire BlueCross BlueShield have announced their latest partnership. The new partnership, centered on value-based care, is designed to lower costs while improving health outcomes for Long Islanders, according to a news release.

Rather than using a fee-for-service model, a value-based care model takes into consideration the quality of care that is provided. It is directly correlated to the patient’s outcome. Proponents of this model say it reduces overall spending and results in better overall health for the patient.

In the partnership between Catholic Health and Empire, Catholic Health’s payment rates will be connected to improved health outcomes and quality-of-care indicators.

“Value-based care is transforming the health care industry and Catholic Health is at the forefront of that transformation,” Julie Kapoor, senior vice president of revenue management and managed care at Catholic Health, said in a news release about the new partnership.

Value-based care has received a lot of attention recently. The New England Journal of Medicine defines it as a model “in which providers, including hospitals and physicians, are paid based on patient health outcomes. Under value-based care agreements, providers are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.”

Kapoor said that the “partnership with Empire BlueCross BlueShield helps us to proactively identify opportunities to reduce the costs of care while improving patient health. The signing of this agreement will allow us to stay focused on the delivery of exceptional care while also improving access to affordable health services on Long Island.”

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The model, Kapoor said, puts the patient at the center, with an eye toward overall good health.

Value-based care “models facilitate access to more comprehensive healthcare data, allowing us to build deeper relationships with our patients, which leads to the delivery of higher quality outcomes,” Kapoor told LIBN.

“The focus shifts from ‘sick care” to ;well care,’ which emphasizes preventive measures to maintain health,” Kapoor said.

In this model, providers “are able to work with the patient to ensure the right care at the right time is coordinated for that patient to meet his or her needs while promoting adherence to treatment. It allows us to see where there might be gaps in care such as cholesterol screens and mammography,” Kapoor said.

“We in turn are able to work with the patient and insurer to best coordinate the care needed to address those important tests and screenings, which can be critical when assessing rising risk for a patient, especially a patient who has a number of health concerns,” Kapoor said. “Identifying and addressing care needs early results in more favorable health outcomes for the patients as well as lower cost.”

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In addition, according to Catholic Health, aligning payment to quality outcomes  – including readmission rates, patient safety and patient satisfaction – helps in such areas as increasing preventive care, improving chronic condition management, reducing hospital admissions, incentivizing whole health.

Ultimately, the focus is designed to lower costs for not only Long Island healthcare consumers but also their employers.

“Our continued partnership with Catholic Health will keep care affordable for Long Islanders by aligning payments with health outcomes instead of on the volume of care provided—a win-win for employers and consumers,” Daniel Jorgenson, vice president of Healthcare Networks at Empire BlueCross BlueShield, said in the news release.

The organizations are using an electronic medical record system, Epic Payer Platform, to exchange information between the healthcare provider and the health plan. The data-driven platform is designed to streamline communications between the two parties, with the goal of simplifying care and improving healthcare outcomes for patients.  Catholic Health is the first health system in the state to deploy the platform, according to Empire BlueCross BlueShield.

“At Empire, we are focused on our mission to improve the health of all New Yorkers,” Jorgenson said. “When we have an innovative partner like Catholic Health, who shares our openness to creative thinking, we are better able to make a real difference in the lives of our members. There is no health system that has made a more meaningful commitment to our value-based relationship, including being the first system in New York to join with us on the Epic Payer Platform to support communications between payers and providers. We look forward to continuing to grow this important partnership.”

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Earlier this year, Catholic Health and Catholic Health Physician Partners Accountable Care Organization announced a collaboration with the CVS ACO, a division of CVS Health based in Woonsocket, RI. With this collaboration, the organizations aim to expand value-based care and health care access for Medicare beneficiaries across the Catholic Health Physician Network in New York.


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