Hospital-insurer team offers health plan

Winthrop-University Hospital is holding a mini-med school adult Winthrop-University Hospital is holding a mini-med school adult education program consisting of five classes on five consecutive Wednesdays beginning next week. Each class centers on parts of the body and how they work. Photo Credit: Bloomberg News

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It's a collaboration that might seem out of "The Odd Couple" but could be the wave of the future.

North Shore-Long Island Jewish Health System, the largest health care system in the region, and UnitedHealthcare, the largest health insurer in the country, have announced they are teaming up to offer health plans beginning Jan. 1 targeted to small- and midsized businesses in Nassau, Suffolk and Queens counties.

These are the first such health benefit plans being offered by a major insurer and hospital system in the metropolitan area, according to North Shore-LIJ, which approached the health insurer about 18 months ago.

"Generally we don't sit at the same side of the table," said North Shore-LIJ chief executive Michael Dowling at a news conference Tuesday at North Shore University Hospital in Manhasset announcing the collaboration. "But we want to be at the forefront of change and so does UnitedHealthcare."

Jeffrey Alter, who heads UnitedHealthcare's commercial business nationally, called the partnership "a bit of an experiment."

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"We hope it will be the cure for what ails us," he said, referring to rising costs and lower quality of health care nationally. "We think it is the idea of the future."

Plan members will use about 5,000 of North Shore-LIJ's doctors, 16 hospitals and hundreds of outpatient sites, although they can opt out to use nonsystem doctors at a higher cost.

What makes the partnership innovative is that North Shore-LIJ will be reimbursed by UnitedHealthcare in part for keeping people healthy and for saving money.

"We're not going to wait for people to come through the door," said Howard Gold, senior vice president for managed care and business development at North Shore-LIJ.

Instead, he said, the health system will reach out to patients, especially those with chronic diseases, to try to keep them as healthy as possible and out of the hospital, which costs more.

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This approach is at the heart of President Barack Obama's Affordable Care Act. The idea is to improve the quality of care and lower costs by paying doctors and hospitals, not based on each service they perform, but on the overall health of the patient.

But Dowling made it clear he wasn't pegging the partnership to the fate of the Affordable Care Act, which Republican challenger Mitt Romney has vowed to repeal.

"I don't care what happens to the" Affordable Care Act, he said. "The idea is for us to be going forward."

Bill Golden, who heads UnitedHealthcare's commercial business in New York, said the plans would be "competitively priced."

Keith Zuckerman, president of Professional Group Plans in Hauppauge, the largest employee benefits insurance agency in the region, said he thought the plans would appeal to businesses with employees close to North Shore-LIJ facilities, especially given the reputation of both the health system and UnitedHealthcare.

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