Montefiore and Oxford Reach Agreement

Montefiore and Oxford Reach Agreement

​Good news Bronx/Westchester.  Oxford and Montefiore Health System announced moments ago that they have reached an agreement effective December 1, 2021 for UnitedHealthcare and Oxford employer-sponsored plans, as well as UnitedHealthcare’s Medicare Dual Special Needs Plan.  

This resolves a split since Jan 1, 2021 which affected a significant percentage of local residents as both companies have a critical size of the market. Westchester and Bronx populations total nearly 2.5 million people. While this contract is resolved with titanic and a few Hospital Systems and Insurers left in the market we expect to see this trend to continue.

See below the official press release. 


UnitedHealthcare and Montefiore Health System Renew Relationship

UnitedHealthcare and Montefiore Health System have reached a multi-year agreement that restores access to Montefiore’s hospitals and physicians for people enrolled in UnitedHealthcare and Oxford employer-sponsored plans as well as UnitedHealthcare’s Medicare Dual Special Needs Plan, effective Dec. 1, 2021.

We recognize that the care Montefiore provides is not only important but also personal to our members and we also know the negotiations process may have been difficult for them. Our top priority throughout this process was ensuring the people and employers we’re honored to serve in New York have access to quality, more affordable health care, and this new agreement helps accomplish that goal.

We thank our members and customers for their support and patience throughout this process. We are honored to continue supporting the more than 3.7 million individuals across New York who depend on us for access to quality and affordable health care.

Montefiore Hospitals & Health System

Facility NameCounty
Montefiore Hospital (Moses Campus)Bronx
Children’s Hospital at MontefioreBronx
Garnet Health MedJack D. Weiler Hospital (Einstein Campus)ical CenterBronx
Montefiore Wakefield Hospital (Wakefield Campus)Bronx
Burke Rehabilitation HospitalWestchester
Montefiore Mount Vernon HospitalWestchester
Montefiore New Rochelle HospitalWestchester
Montefiore Nyack HospitalRockland
Montefiore St Luke’s Cornwall HospitalOrange
White Plains HospitalBronx
Montefiore Hutchinson CampusBronx
Montefiore Medical GroupWestchester
Montefiore Medical Specialists of WestchesterWestchester


Neighboring Hospitals

Facility NameCounty
Bon Secours Community Hospital
BronxCare Hospital Center
Garnet Health Medical Center
Good Samaritan Hospital of Suffern
New York Presbyterian Hudson Valley Hospital
New York Presbyterian Lawrence Hospital
NYC Health + Hospitals Jacobi
NYC Health + Hospitals Lincoln
NYC Health + Hospitals North Central Bronx
St. Anthony Community Hospital
St. Barnabas Hospital
St. John’s Riverside Hospital
Westchester Medical Center

Leading Health Insurers 

2021 Empire Blue Cross Blue Shield
2021 EmblemHealth 
2021 Healthfirst Plans
2021 New Oscar Circle Plus




For information about transparency providers and new tech tools contact us at or (855)667-4621.

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2018’s Top Ten Best & Worst States for Health Care

2018’s Top Ten Best & Worst States for Health Care

2018’s Top Ten Best & Worst States for Health Care

Vermont is the best state for healthcare, according to an 2018’s Best & Worst States for Health Care  analysis by WalletHub.

To identify the best and worst states for healthcare, WalletHub analysts compared the 50 states and the District of Columbia on 40 key metrics of healthcare cost, accessibility and outcomes. The metrics range from physicians per capita to average monthly insurance premiums. Each measure was graded on a 100-point scale, with 100 representing the best healthcare at the most reasonable cost.

Here are the 10 best states for healthcare based on the analysis: 2010 Worst 10 Sates Healthcare

1. Vermont

2. Massachusetts

3. New Hampshire

4. Minnesota

5. Hawaii

6. Rhode Island

7. Colorado

8. District of Columbia

9. Iowa

10. Maryland

Here are the 10 worst states for healthcare based on the analysis:

1. Louisiana

2. Mississippi

3. Alaska

4. Arkansas

5. North Carolina

6. Alabama

7. Oklahoma

8. South Carolina

9. Georgia

10. Florida

Access additional information on the metrics used for the analysis here.

Top 10 medical innovations for 2017

Top 10 medical innovations for 2017

Top 10 medical innovations for 2017

The Cleveland Clinic announced its list of the top 10 medical innovations for 2017  that have the potential to transform healthcare.cleveland-clinic

The 11th annual list was announced Wednesday during the Cleveland Clinic 2016 Medical Innovation Summit, held this week at the Huntington Convention Center of Cleveland and the adjacent Global Center for Health Innovation.

A team of more than 100 doctors and researchers assembled by the Clinic examined nearly 200 nominations to identify and rank the top 10 innovations. The panel doesn’t highlight brands or companies, but rather the innovation and its potential applications in healthcare.

The Top 10 Medical Innovations of 2017 are listed below in order of anticipated importance:

1. Using the microbiome to prevent, diagnose and treat disease

Trillions of bacteria in the body make up communities known as the microbiome. Within the last 10 years, researchers have discovered that the chemicals microbes emit can interfere with how food is digested, medicine is deployed or how a diseases progresses.

The National Microbiome Initiative has accelerated research and development, and biotech companies are looking at the microbiome’s potential to develop new diagnostics or therapies and probiotic products to prevent microbe imbalances.

Experts believe that next year the microbiome will solidify itself as “the health care industry’s most promising and lucrative frontier,” according to a news release.

2. Diabetes drugs that reduce cardiovascular disease and death

In the past, medications have fallen far short of addressing the mortality rates for type 2 diabetes. Half will die from complications from cardiovascular disease. Those odds reach 70% after the age of 65. But new medications began dropping mortality rates this year.

Empaglifozin modifies the progression of heart disease by working with the kidneys, and liraglutide has a comprehensive effect on many organs, according to the release.

2017 could bring a complete shift in the medicines prescribed and further research into new ways to target type 2 diabetes, experts predict.

3. Cellular immunotherapy to treat leukemia and lymphomas

One of the first cellular immunotherapies is about to hit the market, and early results suggest leukemia and non-Hodgkin lymphomas might be curable, even in advanced stages, according to the release.

Chimeric antigen receptor (CAR) T-cell therapies are a form of immunotherapy in which T-cells are removed and genetically reprogrammed to find and destroy tumor cells. After attacking and killing foreign cancer cells, they often remain to minimize the risk of relapse.

The treatment, results for which have been impressive, is expected to be presented to the U.S. Food and Drug Administration next year for treatment for acute lymphoblastic leukemia.

4. Liquid biopsies to find circulating tumor DNA

“Liquid biopsies” are blood tests that uncover signs of actual DNA, or cell-free circulating tumor DNA (ctDNA), which is shed from a tumor into the bloodstream and is more than 100 times more abundant in blood than tumor cells.

Several companies are developing testing kits expected to hit the market this year.

Liquid biopsies are being hailed as a flagship technology of the Cancer Moonshot Initiative, a national effort to end cancer.

5. Automated car safety features and driverless capabilities

New automatic safety features could make a dent in dangerous car accidents, which remain a leading cause of death and disability as well as a major expense. In 2015, there were 38,300 fatal car crashes in 2015, and medical costs nationwide in one year total nearly $23 billion nationwide.

The automated features include collision warning systems, drowsiness alerts and adaptive cruise control. More are likely coming.

Though legal and safety questions remain, major investments into driverless cars are being made by software, private transportation and auto manufacturing companies.

6. Fast healthcare interoperability resources

For many years, billing departments, doctors’ offices, insurance companies and more have operated with systems that couldn’t talk with each other. Experts predict that 2017 is the year to make sense of this tangled web.

An international committee called HL7 will soon release a new tool, FHIR (Fast Healthcare Interoperability Resources), which will serve as an interpreter between systems or offices. The first release will focus on clinical data while the second will look at administrative data, with the potential to end a lot of frustration.

7. Ketamine for treatment-resistant depression

For one third of patients with depression, medications don’t work. Alternatives include intensive treatment options, such as electroconvulsive therapy.

Initial studies of ketamine, a drug commonly used for anesthesia, indicated that 70% of patients with treatment-resistant-depression (“TRD”) saw an improvement in symptoms within 24 hours of a low-dose injection. Ketamine, also known in the 1960s as a party drug, was studied for its ability to target and inhibit the action of N-methyl-D-aspartate (“NMDA”) receptors of nerve cells.

The FDA granted Fast Track Status to the development of a new NMDA-receptor-targeting medications based on the ketamine profile. The FDA gave some, like esketamine, breakthrough status, enhancing the potential for these drugs to be available to patients in 2017.

8. 3D visualization and augmented reality for surgery

Two of the most intricate surgical practices, ophthalmology and neurology, began experimenting in the past year with technology that allows surgeons to keep their heads up while using high-resolution, 3D visual representations of their subjects.

Using data, stereoscopic systems create visual templates. Surgeons who’ve piloted the technology say it brings added comfort and visual information that allows them to operate more effectively and efficiently while also giving medical residents a clear picture of what they’re doing.

Augmented reality glasses that display holographic images of human anatomy could bring the end of cadaver labs at medical schools.

Along the same lines, software companies are building augmented reality glasses that display holographic images of human anatomy. Medical schools see the end of cadaver labs. The Clinic and Case Western Reserve University were among the early adopters to work with Microsoft’s HoloLens, a mixed reality device that allows users to interact with holograms.

9. Self-administered HPV test

Most sexually active woman contract the human papilloma virus (HPV), certain strains of which are responsible for 99% of cases of cervical cancer. The most common malignancy is in women 35 years and younger.

HPV prevention and treatment, which have made great strides, are restricted to women who have access to tests and vaccines.

An approach to expand that care will launch in 2017 with self-administered HPV test kits developed by scientists with the idea that women can mail samples to a lab and be alerted to dangerous HPV strains.

10. Bioabsorbable stents

In July, the first bioabsorbable stent was approved in the U.S. The stent, made of a naturally dissolving polymer, widens clogged arteries for two years before being absorbed much like dissolvable sutures, leaving behind a healthy natural artery.

Annually 600,000 people are treated for coronary artery blockage with metal coronary stents, which stay in their chests permanently most of the time. These stents may inhibit natural blood flow or cause other complications.

Experts believe the market potential for absorbable stents will approach $2 billion in six years.

Cleveland Clinic announces top 10 medical innovations for 2017” originally appeared in Crain’s Cleveland Business.

Mergesurance Mania

Mergesurance Mania

Mergersurance Mania

Insurance mergers aka Mergersurance Mania continues at a steady pace with April 2016 Florida’s approval of Anthem Blue Cross and CIGNA merger.  This is one month after Florida approved the Aetna and Humana merger.  Investors have given their blessings to be sure while 10 States have also given approval. The Anthem Cigna $54 billion merger leaves only three national major providers of health care. Worries remain about the potential effect on consumers and the rising cost of health care.Hospital Mergers

Health Insurers consolidation argument are that they need to be able to  merge in order to absorb added costs and blunted profit margins under the Affordable Care Act.  Additionally, medical groups and hospitals groups have merged themselves rapidly giving them negotiation cost controls. This has traditionally been trending in smaller regional markets but are now also felt in major US Cities.

Evidence indeed is pointing to expected large insurance increases due to overwhelming market domination by hospitals. While Doctors and AMA are rightfully concerned about Insurer mergers the vast majority are now working for a Hospital System or Medical IPA.

Without public outcry there seems to be lax Regulator oversight and the  arms race should not come as a surprise.  On the local level we have yet to see a recent example of hospital merger that was curtailed.

This goes well beyond political partisanship. In a tight Presidential race it is important to understand that whether or not one supports a Single Payer we all suffer.  This is bad for consumers, providers and tax payer all around.  In an Oligopoly health care system with lack of competition the U.S. tax payers are also stuck with inflated costs.

Past Articles:

Breaking: Maimonides North Shore LIJ Partnership Aug 2015
Montefiore Buying Sound Shore Hospital  May 2013
 NYU Beth Israel Hospital Merger and ACO June 2012
HIP/GHI Merger Mar 2008






Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership

Breaking: Maimonides North Shore LIJ Partnership
Breaking News: NSLIJ, and Brooklyn’s Maimonides Announce Strategic Partnership on Wednesday. Both side shave been in talks since February.

Eventually North Shore-LIJ and Maimonides will fully integrate, “in a phased approach that will begin immediately,” the two jointly announced Wednesday. In the meantime, both institutions maintain their independence and separate governance structures. Lynam said there was no specific time frame for full integration.

Maimonides gets much-needed cash — tens of millions of dollars — for capital and operational investments. That will help it compete with Presbyterian-backed Methodist and Langone-backed Lutheran. North Shore-LIJ gets its first real foothold in #Brooklyn, one of the most competitive health care markets in the nation. But it does so without the commitment that a full-scale merger would entail. An affiliation agreement also protects North Shore-LIJ from unknown liabilities related to the Federation of Jewish Philanthropies, a malpractice insurer that covers Maimonides and several other hospitals

North Shore-LIJ  has made strategic partnerships and acquisitions before.  For North Shore-LIJ, the relationship means it has a hospital or hospitals in every borough as well as blanketing Westchester and Long Island.  North Shore-LIJ, the country’s 14th largest health care system, owns 19 hospitals. In the city that includes Lenox Hill Hospital in Manhattan, Staten Island University Hospital, and, in Queens, Forest Hills Hospital, Long Island Jewish Medical Center, Cohen Children’s Medical Center and Zucker Hillside Hospital, a behavioral health center.

They are also actively insuring members today in the Downstate NY area under the CareConnect NSLIJ holding company.  With important advantages under ACA and mindful of delivering value the insurance arm is priced affordably.  In fact they had lowered their rates 15-20% for 2015 and and industry low 3.3% for 2016.

For more information on 

See PR Announcement here
Related Posts: NSLIJ CareConnect adds WestMed
NSLIJ Adds Phelps Hospital
CareConnect NSLIJ
NYS 2016 Rates Approved
How Your Hospital Ranks

How Your Hospital Ranks

How Your Hospital Ranks CMS Hospital Rankings

With first new star rankings released yesterday by CMS (Center for Medicare & Medicaid Services) this will be a little easier for consumers.  The role of Government in medical transparency have long been touted as a qualitative and cost factor.   The patient experience Star Ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality.

The Hospital Compare star ratings relate to patients’ experience of care at almost 3,500 Medicare-certified acute care hospitals. The ratings are based on data from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS) measures that are included in Hospital Compare. HCAHPS has been in use since 2006 to measure patients’ perspectives of hospital care, and includes topics like:

•           How well nurses and doctors communicated with patients

•           How responsive hospital staff were to patient needs

•           How clean and quiet hospital environments were

•           How well patients were prepared for post-hospital settings

Only 251 hospitals–or 7 percent of those ranked–received a five-star rating under the new system, Kaiser Health News reported. The largest share of hospitals (40 percent) received three stars, including highly respected institutions such as Cedars-Sinai Medical Center in Los Angeles, NewYork-Presbyterian Hospital in Manhattan and Northwestern Memorial Hospital in Chicago. Only 3 percent of hospitals netted one star.

Consumers will now see 12 HCAHPS Star Ratings on Hospital Compare, one for each of the 11 publicly reported HCAHPS measures, plus a summary star rating that combines or rolls up all the HCAHPS Star Ratings. These star ratings will be updated each quarter.  Also, the Nursing Home Compare site already uses star ratings to help consumers compare nursing homes and choose one based on quality.

For more information on yesterday’s announcement, please visit here: