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NYSlant.com
A fresh perspective on opinions Edited by NICK POWELL Our Slant
A health care transformation THOMAS EDISON’S LIGHTBULB changed the world, but we know from history that adapting to change wasn’t easy or fast. Like the game-changing lightbulb, one of the most important transformations to occur in health care is value-based payment. A small number of health plans in New York state have carved the path for this transformative reform policy – moving from paying for the number of services provided to paying for quality of health outcomes – and it’s revolutionizing the health care system. For too long,
AMERICANS HAVE PAID TOO MUCH AND RECEIVED TOO LITTLE from their health care spending. The model in which payment is made solely based on the number of services performed won’t help us maintain the best health care system in the world. That model rewards waste, and encourages more care rather than the right care. Value-based care replaces paying for a whatever-you-get system, and instead moves the focus to the quality of care being provided. The path forward requires health plans, physicians and hospitals to work together to ensure that patients receive the right care, at the right time, and in the right place. This involves both rewards and risk sharing, and entering into relationships with many of New York’s leading clinicians and hospitals that are willing to take responsibility for achieving results. The impact of this change on patients is that it puts them at the center of the system, because providers and health plans are aligned in achieving better health
By KAREN IGNAGNI
outcomes, better quality of service and better results. Currently, more than 60 percent of EmblemHealth’s HMO members have selected a value-based plan. Our physician partners are seeing reductions in inappropriate admissions, reductions in emergency room visits, earlier intervention and better quality. The goals we share with our provider partners are to make care more convenient, increase patient satisfaction, and improve health. We also believe that it’s important that our members and practitioners be connected, and we are using some of the most innovative technologies to provide online scheduling, portable patient records, and data support. New York state has set the goal of moving 80 to 90 percent of payments to a valuebased system. We applaud the state’s leadership and, as leaders in this evolution, we plan to meet that goal much earlier. To accomplish this, we are working actively with our physician group partners but also offering data and infrastructure support to independent doctors that want to embrace this model. As the industry continues to evolve, the shift to quality over quantity will speed up, and New York’s health care will improve. We are committed to playing a leading role in creating a healthier New York, and helping usher in a health care system that is one of the most affordable as well as the most effective.
Karen Ignagni is president and CEO of EmblemHealth.
NICOLE GELINAS -
SLANT COLUMNIST
NEW YORK TRANSIT AND THE LEGACY OF 9/11 Nearly a decade and a half after 9/11, it’s obvious that the foreign-policy decisions Washington made after the attacks were not the best. The recent opening of the new PATH train terminal at the World Trade Center site shows how New York officials, too, fell short of what they owed their state and city. The station is nearly five years late, and cost twice its initial budget. And it does not add train service or make commuting less crowded or faster for the New Jersey subway riders who will use it. Most of the mistakes New York made had nothing to do with 9/11. In fact, they are repeats of the mistakes that have long plagued our infrastructure decisions. First, the Port Authority – and former Gov. George Pataki and his New Jersey counterparts – failed to be realistic about costs, and how an untested design would strain those costs. This failure to control risks and costs is an unfortunate New York tradition. The state’s project to bring the Long Island Rail Road into Grand Central was once supposed to cost $3 billion and be done by 2009, but now costs $10.2 billion and won’t be finished before 2022. The second mistake New York and New Jersey made was their failure to prioritize. Is the station a piece of infrastructure, or a monument? What New York needs, and needed before 9/11, is better transit capacity. New Jersey commuters need a new tunnel under the Hudson River before the existing one, more than a century old, falls apart. New Yorkers need more subway trains per hour to ease crowding. The problem, though, is that these needs aren’t critical in lower Manhattan. But New York had federal money to spend in lower Manhattan, so it did, and when that money ran out, the authority ended up spending its own money – $1.2 billion – on a station it didn’t need. The third problem is our failure to think about the region holistically. The Port Authority is supposed to serve both New York and New Jersey – and do the best it can for commuters. Instead, it runs on a “tit-for-tat” philosophy – doing one thing for New York means doing another thing for New Jersey. After the Port Authority took over Stewart Airport in upstate New York, it had to take over the Atlantic City airport – even though neither project has anything to do with the authority’s mission of improving life for downstate commuters. Nobody in power wakes up thinking, “What are the top three projects that are best for everyone – and how do we get those thing done?” The fourth and final problem is one that afflicts the entire country: thinking that money alone will solve our infrastructure problems. We need money to build and fix infrastructure, yes – more than we’re spending. But if you want to see how money isn’t everything, go downtown and see billions of dollars’ worth of marble and steel that doesn’t help anyone get from Point A to Point B.