Health and Safety

EmblemHealth Programs Eliminate Need for Rate Increase in 2014

August 12, 2013
By Stephanie West

New York, NY  — As a result of investments in coordination of patient care and expanded programs to improve quality and wellness, EmblemHealth informed New York State officials on July 31 that it would not seek 2014 premium rate increases for its HMO business, which covers 350,000 members, approximately 200,000 of whom are City employees. Rate increases are driven by the cost and usage of medical services. EmblemHealth’s programs which focus on coordination of patient care, quality and patient wellness are producing measurable success.

The rate filing process is prescribed by the Department of Financial Services (DFS), and EmblemHealth follows actuarial best practice in evaluating its premium rates. Since EmblemHealth is not requesting 2014 rate increases above those approved by DFS on October 17, 2012 for the HMO business, increases for employer groups will be lower throughout 2014. For example, the premium increase for the City of New York, which renews on July 1, 2014, will be 1.2 percent.

“EmblemHealth and its companies Group Health Incorporated (GHI) and Health Insurance Plan (HIP) of New York have been in the forefront of health care reform for 70 years, creating and improving models for high-quality, affordable health insurance,” said EmblemHealth Chairman and CEO Frank Branchini.

EmblemHealth’s investment in AdvantageCare Physicians (ACP) is one of the company’s most important quality and cost management strategies. ACP is a physician practice with more than 425 primary care providers in 39 locations, one of the largest group practices in the metropolitan area. EmblemHealth and ACP have been able to provide efficient, lower cost, high quality care and improve health outcomes through enhanced care coordination, delivery of appropriate levels of care, with increased patient satisfaction.

EmblemHealth’s Point-of-Care case management model, located within its physician practices, coordinates care to help hospitalized members transition out of the hospital. The members within the Point-of-Care program have experienced a 31 percent reduction in readmission rates and a 43 percent reduction in days hospitalized, resulting in a lower total cost of care. The company also offers its members a variety of comprehensive wellness and disease management programs.

EmblemHealth, Inc., through its companies Group Health Incorporated (GHI) and HIP Health Plan of New York (HIP), provides quality health care coverage and administrative services to approximately 3.4 million people.

August 12, 2013

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.