Hospitals vs. Insurers

Crain’s Health Pulse
Feb. 28, 2014
Hospitals vs. Insurers

When North Shore-LIJ introduced its insurance plan, CareConnect, last year, it did so partly in response to market dynamics, said Mark Claster, president of Carl Marks & Co., and vice chair of the board of trustees at the health system. "When a hospital negotiates with United, or with Aetna or EmblemHealth, they're telling us how much they're going to pay us to take care of [a patient]," he said. "They're dictating to us. So if you're in a risk-based environment anyway, why not control that premium?" The move toward managing population health, or course, comes at a time of recognition of overtreatment and waste in certain areas of medicine. "If more [treatment] was better, this would be a problem," Mr. Claster said. "But more isn't better, and going to a risk-based model where there's metrics and you get paid more if you do better—it's the right thing for us to do," he said.

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