New York, NY Market Overview

HealthLeaders Interstudy, June 2011, Pages: 70

Consolidation and affiliations are increasing among health systems in the New York City market, which includes a high concentration of academic medical centers. Leading health systems are hiring many physicians. A new state budget law limits Medicaid spending and transfers management of the Medicaid pharmacy benefit to managed care organizations. The law also provides financial support for patient-centered medical homes. Employers are shifting more costs to workers and limiting coverage choices.

Questions Answered in this report

In the New York City market, small hospitals are struggling while large academic medical centers are performing well financially and preparing to form accountable care organizations. Which hospitals in New York City closed in 2010? Which healthcare systems are planning accountable care organizations? Which health systems announced a new affiliation to share best practices? By what percentage did New York lawmakers reduce Medicaid reimbursement rates for providers as of April 2011?

Many physicians, faced with flat reimbursements, are signing employment contracts with health systems. Medical group mergers also are on the rise in the New York City market, and acceptance is growing for the patient-centered medical home model. Which health systems were the most active in hiring physicians in 2010? What are names of the top three physician organizations? Which medical groups merged on Staten Island? How many physicians in the Hudson Valley area received incentives for achieving medical home recognition? What is the name of the new medical school on Long Island?

A new state law moves management of the New York Medicaid Pharmacy benefits to Medicaid managed care plans as of April 2011. Other new state laws put additional restrictions on managed care organizations. What are the provisions of the new state law regarding specialty drug tiers? What action did the New York Legislature take regarding health insurance rate increases? How does New York’s new medical loss ratio requirement compare with the federal requirement? Which managed care organization is offering a narrow-network product with two tiers that provide higher cost sharing for members who select hospitals outside a preferred network?

Metrics
- Key market indicators and leading organizations among health systems, physicians and health plans
- Health systems’ market share
- Income, revenue, enrollment and pharmacy spend for leading health plans
- Demographics

New York City Market
- Market Indicators
- Leading Organizations
- Market Stage

Management Summary
- Outlook
- Health Systems and Hospitals
- Physicians
- Health Plans
- Medicaid/Medicare/Uninsured
- Pharmacy
- Legislation
- Employers

Health Systems & Hospitals
- NewYork-Presbyterian Healthcare System
-- Description
-- News and Analysis
- North Shore-Long Island Jewish Health System
-- Description
-- News and Analysis
- New York City Health and Hospitals Corp.
-- Description
-- News and Analysis
- Other Health Systems and Hospitals

Physicians
- Taconic IPA
- Montefiore Integrated Provider Association
- ColumbiaDoctors
- Faculty Practice Associates at Mount Sinai School of Medicine
- Medical Faculty Health Alliance IPA
- Additional Physician Organizations

Health Plans
- WellPoint (Empire Blue Cross Blue Shield)
- UnitedHealth Group
- EmblemHealth

Medicaid/Medicare/Uninsured
- Medicaid
- Medicare
- Uninsured

Pharmacy

Legislation

Employers
- Business Coalitions

Demographics & Statistics

- New York-Presbyterian Healthcare System
- North Shore-Long Island Jewish Health System
- New York City Health and Hospitals Corp.
- WellPoint (Empire Blue Cross Blue Shield)
- UnitedHealth Group (UnitedHealthcare and Oxford Health Plans)
- EmblemHealth
- Taconic IPA
- Montefiore Integrated Provider Association
- ColumbiaDoctors
- Faculty Practice Associates at Mount Sinai School of Medicine
- Medical Faculty Health Alliance IPA
- New York Business Group on Health
- Business Council of New York State
- Westchester County Association
- Rockland Business Association

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