“If I were Atilla the Hun not for profit hospital CEO looking to control an entire universe and make a gazillion bucks along the way, I would…………”
Northwell Direct announce largest direct health care contract of its kind
By Doug Aldeen • ERISA Healthcare Attorney and Fractional General Counsel – Visit my website
32BJ Health Fund, the union health fund representing 100,000 building service workers in the New York metro area, and Northwell Direct, a direct-to-employer health care network that partners directly with employers and labor unions to provide health benefits solutions to their employees, this week announced a historic deal that will significantly expand access to high-quality care for 32BJ members and their families while delivering dramatic savings to patients, unions and employers. This agreement is the largest direct health care contract of its kind in the country.
Under the terms of the deal, the 170,000 participants in the 32BJ Health Fund will have access to the full spectrum of health care services available through the Northwell Direct network. As a result of the lower prices available through Northwell Direct, 32BJ Health Fund estimates it will save $46M in the first year of the agreement A layer of third-party administration will be removed because Northwell Direct and 32BJ Health Fund will manage the administrative relationship directly. 32BJ Health Fund will return Northwell Health to Preferred status. The result will be more options at lower costs for 32BJ members.
Sunday Morning Bathroom Read Takeaway:
If I were Atilla the Hun not for profit hospital CEO looking to control an entire universe and make a gazillion bucks along the way, I would recommend the following:
Immediately implement the above strategy across every employer in the marke;t
- Form a provider sponsored health insurance plan under capitation;
- Form a joint venture with every other facility/clinic in the region whereby the joint venture partners keep 85% of the premium ( capitation) and the other 15% goes to the actual organization that owns the insurance company. The joint venture partners are able to get into the insurance game without the corresponding regulatory approval. c) below. This is a “GFD.” (“Great F%$#@!* Deal).
This organization, whatever it is to be named ( ATH “Atilla the Hun” Health System), controls the entire level of reimbuement to its own doctors that control the insurance carrier and effectively keeps out any other payer because they will not get competitive rates. This is what’s called a “win- win-win-win-win” situation:
a) the doctors that own and control the insurance company control their own level of reimbursement;
b) the doctors can effectively bar any other payer from entering and competing in the market. See (a);
c)joint venture partners can be part owners of an insurance company without meeting any of the regulatory requirements. Read: “GFD” Great F&%$&!) Deal;
d) The provider sponsored insurance company is really a marketing arm to capture market share.
e) Depending upon your point of view, publicly traded health insurance carriers look less attractive as an investment.
