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EmblemHealth, Northwell form agreement for shared-risk

The health plan and provider will look to one another to manage patient access, cost of care, outcomes, EmblemHealth said.

Susan Morse, Managing Editor

Image via <a href="">Wikipedia</a>.Image via Wikipedia.

EmblemHealth and Northwell Health in New York have agreed to share risk in value-based contracts, EmblemHealth announced March 25.

Under the new agreement, the health plan and provider - formerly  North Shore - LIJ Health System - will look to one another to manage patient access, cost of care and outcomes, EmblemHealth said.

Tangible results have already been shown in a 10 percent reduction in emergency room admissions in locations where the two organizations have collaborated, the release said.

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"Integrated care management is one of the most effective tools to improve the overall well-being of patients and deliver effective care," said Karen Ignagni, president and CEO of EmblemHealth.

[Also: Emblem Health study shows inpatient case management reduces readmissions]

Ignagni is the former CEO of America's Health Insurance Plans. She took over as head of EmblemHealth last year after Fitch Ratings lowered the credit rating of EmblemHealth subsidiaries Health Insurance Plan of Greater New York, from BBB to BB+ in June 2015.

The rating downgrade reflected a net loss of $494 million in 2014 and a $40 million loss in the first quarter of 2015, Fitch said. The subsidiaries  reported underwriting losses in comprehensive hospital and medical, Medicare and Medicaid business lines, Fitch said.

In September 2015 Fitch affirmed a BBB- rating and said the rating outlook was stable.

EmblemHealth provides health coverage to more than 3 million people in the New York tri-state area.

[Also: Northwell Health holds $100,000 voting contest to fund three new medical innovations]

Northwell Health has 21 hospitals and nearly 450 outpatient practices, which serve more than 1.8 million people a year in the metro New York area and beyond.

The new agreement builds upon the organizations' shared 20-year relationship, according to the release.

"Both organizations have built our capabilities in tandem helping each other improve on the promise of integrating and coordinating care across a continuum," said Michael Dowling, president and CEO of Northwell Health. 

Twitter: @SusanJMorse