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Montefiore Medical Center Signs ACO Agreement with Empire BlueCross BlueShield

New Agreement Will Offer Patient Centered Primary Care Programs to Empire Members in Bronx and Westchester

New York City, NY (September 18, 2012) Montefiore Medical Center and Empire BlueCross BlueShield announced today that they have signed an Accountable Care Organization (ACO) agreement under which advanced care management services will be offered to Empire's Fully Insured members in Bronx and Westchester counties as well as to Montefiore’s ASO plan administered by Empire.  This is the first ACO agreement Empire has entered into in the New York region, having chosen to partner with Montefiore due to its extensive experience in improving the health of patients, improving the healthcare experience and reducing expenditures.

The goal of the new agreement is to help the health plan members stay as healthy as possible by getting the right care in the right place and at the right time, avoiding unnecessary emergency room visits and preventable hospital admissions.  Central to Empire’s ACO development is its Patient Centered Primary Care strategy that requires the development of individualized care plans for patients with chronic or complex conditions and continuous monitoring of their health according to tested guidelines for care and services. Montefiore’s more than 200 specially-trained care managers can provide health education, care transition assistance and various other services to all members, in addition to intensive case management. More than 200,000 residents of the Bronx and lower Westchester are currently covered by agreements between their health insurers and Montefiore Care Management, similar to the Empire agreement.

“Montefiore’s partnership with Empire shows our shared commitment to improving the health and well-being of the Bronx and Westchester and recognizes our forward-thinking approach to health care delivery. For more than 16 years, Montefiore has been building our expertise in innovative care management and coordination and creating a value-based seamless system of care." said Steven M. Safyer, MD, President and CEO of Montefiore Medical Center. “Through this durable arrangement with Empire, we advance our goal of changing health care from a fragmented misaligned system of care to one where patient experience, outcomes and quality come first.”

As part of the new agreement Empire members who are already seeing primary care and specialty physicians affiliated with Montefiore will be eligible for care coordination services to help manage chronic illnesses such as diabetes, coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease and asthma – conditions that are prevalent in the region. Additionally, all members will have access to wellness and preventative care and will receive educational support to encourage and empower them to positively manage their own health.

In the new ACO agreement, Montefiore and Empire will work together to improve the health of members, as well as improve quality and reduce costs. As part of this pay-for-performance model, if quality standards are met, Montefiore will be eligible to receive additional compensation

 “Empire is pleased to partner with Montefiore in this new program that rewards quality outcomes that result in better patient care,” said Mark Wagar, President and CEO of Empire BlueCross Blue Shield. In the end, our members win as we create better access to primary care physicians that will help the member navigate through the complex health care system, making the member active participants in their health care through shared decision making that will result in better health outcomes.

The new agreement is further recognition of Montefiore’s rich experience of managing care and improving outcomes. In December 2011, Montefiore was selected by the Centers for Medicare & Medicaid Innovation (CMMI) to participate in the Pioneer Accountable Care Organization Program.  The Montefiore Accountable Care Organization (ACO) is responsible for 23,000 beneficiaries of the original Medicare program, and is one of only 32 Pioneer ACOs in the nation and the only Pioneer ACO in New York State. Montefiore is also the lead of a consortium of Bronx health care organizations participating in New York State's Health Home care coordination program for Medicaid beneficiaries.

 “At Montefiore we have been practicing the principles of accountable care for nearly two decades,” said Joel A. Perlman, Chief Financial Officer at Montefiore Medical Center. “As this model continues to gain national recognition and momentum, we anticipate that many more insurance companies will recognize the value of this structure and implement shared savings approaches with health care providers, just as Empire BlueCross BlueShield has done.”