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Northwell Health ditches insurers for direct network contracting

Northwell Health will provide health benefits to its 75,000 employees and dependents through a new direct contracting system at the start of the next year, the not-for-profit integrated health system announced Monday.

The New Hyde Park, N.Y.-based company has expanded the partnership with Northwell Direct, a for-profit subsidiary it launched last year that eschews traditional insurers and instead uses a direct network contracting approach with providers.

Northwell Health, the Empire State’s largest healthcare employer, previously had a self-insured plan administered by UnitedHealth Group’s UnitedHealthcare, and also used that insurer’s provider networks. UnitedHealthcare did not respond to an interview request.

“Because this is allowing us to provide care directly to our team members without an intermediary through the network, it allows us to focus on care of our team members as our number one priority,” said Gregg Nevola, vice president and chief rewards officer at Northwell Health. “Our belief is the strongest element within the care model is our physician network and the facility opportunities within that network.”

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The multi-year partnership represents the first time Northwell Health has ever chosen to opt for direct network contracting, which integrated health systems Kaiser Permanente of Oakland, California, and Danville, Pennsylvania-based Geisinger Health System already did, Nevola said.

Northwell Direct offered a pilot of its network contracting program to about 1,500 health system employees and dependents through a high-deductible health plan at the start of this year. Although the program is still new and the population is unrepresentative of the entire workforce’s health needs, the initiative reduced healthcare spending and resulted in better network access and more positive customer service experiences, Nevola said.

Northwell Direct says its approach generally results in a 20% drop in employer healthcare costs compared to traditional insurance plans. Brighton Health Plan Solutions is the third-party administrator that processes claims and operates customer service for Northwell Direct.

“As our geography grows—where our team members live and work—whether it’s through acquisition or their relocation, it’s just such a great opportunity to provide a more vast network for them, as well, through this offering,” said Maxine Carrington, senior vice president and chief human resources officer at Northwell Health.

Northwell Direct’s provider network includes nearly 20,000 physicians in New York and New Jersey. A wrap-around network is available for employees who need care in other states.

In addition to providing health benefits, Northwell Direct offers care management services to employers, such as COVID-19 tools for JetBlue Airways and primary care services for Whole Foods Market. Whole Foods Market employees also have access to direct network contracting through Northwell Direct.

By tightly integrating care management with clinicians’ practice sites, Northwell Direct can promote quality by connecting patients with the same providers throughout their care, and that promise of repeat business enables Northwell Direct to negotiate discounts insurers can’t, said Nick Stefanizzi, the subsidiary’s CEO.

“We’re not going to have everyone in our network, right? We’re not going be the [UnitedHealthgroup] network,” Stefanizzi said. “We’re looking for like-minded, high-quality, high-performing hospitals, health systems and providers to bring into the network and we go to them with a value proposition that says, ‘Look, we know employers are hungry for a new solution in this space.'”

Employers are fed up with rising healthcare costs and the COVID-19 pandemic has worsened the toll health benefits take on employers’ bottom lines, Stefanizzi said.

Over the past decade, the average annual premium employers paid for a family of four’s health benefits rose nearly 55% to $21,342 as of 2020, according to a report the Kaiser Family Foundation and the Purchaser Business Group on Health issue in April. Last year, the average annual premium for single and family coverage rose 4%.

About 40 employers have approached Northwell Direct about offering its direct network contracting benefits to their workers next year, Stefanizzi said.

“We are looking to partner with self-funded employers,” Stefanizzi said. “There’s a willingness and an openness to different solutions, and I think that we have a solution that can meet that moment.”