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Mount Sinai Health System, 32BJ Health Fund, and Empire BlueCross BlueShield Launch Innovative Joint Replacement Program
Newswise — (New York, April 5, 2016) — Today, Mount Sinai Health System (MSHS) announced the launch of a Joint Replacement Bundled Payment Program for hip and knee procedures with 32BJ Health Fund, the health fund for the largest property service workers union in the United States. The program, developed in partnership with MSHS, The Mount Sinai Hospital, 32BJ and Empire BlueCross BlueShield, offers 32BJ members and their dependents hip and knee replacement surgeries at no out-of-pocket cost with a streamlined patient experience during their hospital stay as well as through their recovery.
Unlike traditional fee-for-service medicine, where physicians and hospitals charge independently for each service performed, the bundled payment program establishes a single payment for the entire episode of care — encompassing multiple providers across various settings. The bundle includes costs associated with surgery, recovery, and preventable complications.
Members pay no out-of-pocket costs, such as co-payments or co-insurance, for surgeries or related services if they choose a Mount Sinai orthopedic surgeon participating in the Joint Replacement Bundled Payment Program. The 32BJ Health Fund provides a service representative to guide its members, offering assistance with everything from understanding their benefit plan to finding a surgeon.
“Our goal is to provide our members with the highest quality of evidence-based care and the highest-quality patient experience to garner the best health outcomes, which, in turn, results in lower costs,” said Héctor J. Figueroa, President of 32BJ SEIU and Trustee of the 32BJ Health Fund. “This innovative partnership between MSHS, 32BJ and Empire is a model for how to best serve members while keeping costs low. We are proud to be launching this program that will support the health of our members and allow them to continue to support their families.”
Prior to surgery, patients attend a “Joint Class” to learn about preparing for surgery, as well as recovery. Each 32BJ member is introduced to a care navigator who will assist the patient through the surgery and recovery process, including visiting the member in the hospital to build a customized recovery plan, assisting with the transition home, and following up via phone or email. The 32BJ Fund will also support members by offering assistance with transportation to and/or from the hospital or help once the patient returns home after surgery.
“Bundled payment programs support Mount Sinai’s population health strategy to increase the value for every dollar spent,” said Niyum Gandhi, chief population health officer for MSHS. “We are thrilled to be collaborating with the 32BJ team and Empire to develop this program, teaming up to create value for our common customer: the 32BJ member. We’re taking what we’ve learned from our experience in the bundled payment demonstration with the Centers for Medicare and Medicaid Services (CMS) and expanding it to 32BJ members and dependents. Mount Sinai’s clinicians use care pathways that reduce variation and result in reliable, high-quality outcomes. This program revolves around the patient’s needs and delivers a comprehensive, evidence-based approach to improving the quality of their care and helping them to achieve their ultimate goal — pain-free walking — while also creating significant cost savings and greater predictability for patients and employers.”
“Empire applauds the 32BJ Health Fund for its leadership in fostering innovative methods to continue to provide their hard-working members with great health insurance coverage,” said Tom Canty, Vice President and General Manager, Empire BlueCross BlueShield. “Everything 32BJ does is always in the best interest of their members.”
“As the U.S. health care system and federal government evaluate ways to reduce the cost of health care, payment bundling is emerging as one solution with significant benefits to all involved,” said Howard Rothschild, President of the Realty Advisory Board on Labor Relations and Trustee of the 32BJ Health Fund, “This arrangement with Mount Sinai fosters increased alignment among providers to focus on what matters most to patients — a seamless experience with high-quality outcomes at a predictable and affordable price. And that enhances the participant’s experience.”
For more information about the Joint Replacement Bundled Payment Program, please contact Theresa Dolan at [email protected].
About the Mount Sinai Health SystemThe Mount Sinai Health System is an integrated health system committed to providing distinguished care, conducting transformative research, and advancing biomedical education. Structured around seven hospital campuses and a single medical school, the Health System has an extensive ambulatory network and a range of inpatient and outpatient services—from community-based facilities to tertiary and quaternary care.
The System includes approximately 6,100 primary and specialty care physicians; 12 joint-venture ambulatory surgery centers; more than 140 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. Physicians are affiliated with the renowned Icahn School of Medicine at Mount Sinai, which is ranked among the highest in the nation in National Institutes of Health funding per investigator. The Mount Sinai Hospital is ranked as one of the nation’s top 10 hospitals in Geriatrics, Cardiology/Heart Surgery, and Gastroenterology, and is in the top 25 in five other specialties in the 2015-2016 “Best Hospitals” issue of U.S. News & World Report. Mount Sinai’s Kravis Children’s Hospital also is ranked in seven out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology, while Mount Sinai Beth Israel is ranked regionally.
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