Mount Sinai, Empire BlueCross BlueShield to expand access to home care models


New York-based provider and payer join forces to expand access to value-based models of care to more residents of the state.

Mount Sinai Health System and Empire BlueCross BlueShield have entered into a new agreement whereby Empire members will have access to three new models of care: Mount Sinai Emergency Triage, Treat and Transport; Mount Sinai community paramedicine; and the Mount Sinai Visiting Physicians Program. The agreement runs until December 2025.

“The overriding objective [of the partnership] is a value, ”said Dr. Robert Fields, executive vice president and head of population health at Mount Sinai Health System, in an email. “Having a longer term relationship allows us to plan a phased approach over several years and grow together as partners. “

As a participating provider in the Mount Sinai Triage, Treatment and Emergency Transport and Mount Sinai Community Paramedic models of care, Empire will be able to provide its commercial members with access to care teams. paramedics who have flexibility in terms of emergency response.

For example, the emergency triage, treatment and transport model allows these teams to provide care in a patient’s home instead of taking them to the emergency room, when medically appropriate. This template is also available for Empire Medicaid members.

Likewise, the community paramedicine model allows members who call a clinician in Mount Sinai to choose to have a paramedic dispatched to their home and potentially avoid a trip to the emergency department.

The Mount Sinai Visiting Doctors Program is a model of integrated care focused on homebound limbs. Eligible Empire members who are enrolled in Medicare plans will have access to a dedicated clinical team providing primary and palliative care services.

“Today, as part of our mission, we signed a new agreement with Mount Sinai Health System to give our members more options in terms of when, where and how they receive care,” said Jordan Vidor. , Regional Vice President of Supplier Solutions at Empire BlueCross BlueShield, in the press release. “The new agreement includes several innovative value-based care agreements, with shared incentives to jointly improve the quality of care across our common footprint. “

Empire will participate in all three models of care by the first quarter of 2022.

The new payor-provider agreement not only expands access to value-based care, but also details a plan for Mount Sinai to improve two-way data integration with Empire.

“We work with [Empire] on the interfaces between our different platforms and theirs to promote more transparent data exchange with less manual entry required from either team, ”said Mount Sinai’s Fields.

The partnership is expected to improve the overall cost trend and quality of care, as evidenced by both preventive care measures, such as cancer screenings, and measures that represent chronic disease outcomes, he added. .

This agreement is the latest in a long-standing relationship between the two organizations. In 2015, Empire and Mount Sinai established a Responsible Care Agreement focused on collaborative care and increasing efficiency.

Photo: mediaphotos, Getty Images

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