To improve healthcare and equity for New Yorkers, the state’s largest not-for-profit health insurer leveraged its unique value-based model to return $440 million to the state’s stressed healthcare system
Membership growth of 242,000 as people increasingly turned to government-sponsored Medicaid and Medicare products
NEW YORK, February 24, 2021 – Healthfirst, one of the nation’s largest not-for-profit health insurers, today provided insight into how it stepped up and returned $440 million to hospitals and providers in the state during 2020 as New York’s health system faced the unprecedented challenge of the COVID-19 pandemic.
Additionally, the company announced that it achieved membership growth of 242,000, bringing total membership as of December 31, 2020 to 1,647,453 members and solidifying its position as the largest not-for-profit health insurer in New York (by revenue). Throughout the COVID-19 pandemic Healthfirst has seen increasing numbers of New Yorkers turn to its government-sponsored Medicaid and Medicare products. Medicaid growth was particularly strong as people faced significant economic hardship and job loss caused by the fallout from the pandemic.
The company noted its unique relationship with the local health system and the trust it has built within the communities it serves. Under Healthfirst's unique value-based care model, incentives are aligned around trying to keep people healthy and ensuring that they have appropriate care. Healthfirst and its providers are aligned around the goal of quality care. Providers benefit if they improve the health of patients and reduce the effects of chronic disease. The value-based model rewards the health system and participating providers if patients are well cared for.
"Healthfirst's response to the COVID-19 pandemic, and the amount of funding that we were able to return to the local health system, really points out how we are different from our competitors," said Pat Wang, President and Chief Executive Officer of Healthfirst. "Because we are sponsored by 15 of the largest hospital systems in New York, instead of pocketing profits, we give them back to the health delivery system. Our goals are to keep people healthy and the health system in New York strong."
"During 2020, when hospitals and providers across New York faced record losses and had their business models upended, we were able to leverage our unique model and return a significant amount of surplus revenue "profit" to them," noted Wang. "This provided crucial funds at a critical time as they were caring for our members, their patients. We view this as a win/win for the state of New York, our members, and the hospitals and providers who take care of our members."
"Our response to the COVID-19 pandemic as a community-based health plan was to do everything possible to support our members and the heroic hospitals and healthcare providers at the front lines of this crisis," said Jay Schechtman, MD, Chief Clinical Officer for Healthfirst. "We mounted a massive clinical response to the crisis. For our members, we leveraged data and analytics to identify needs for care management, supplies and equipment, prescription medications, telehealth access, and food resources. For hospitals and providers, we stayed very close to them as they were impacted so severely by the drop in healthcare utilization."
Healthfirst was also able to maintain a strong level of investment throughout 2020 to help members keep healthcare close at hand. This investment included accelerating work and launching the Healthfirst NY Mobile App (available for iOS and Android), which offers members a personalized experience. Additionally, the company accelerated several other digital innovations and corporate initiatives during the year, including the launch of a virtual community office to provide enrollment and support services.