Answers to your questions about Create®
Create is the first and only marketplace of health systems in the New York tri-state area. It's a brand-new concept in healthcare for the New York, New Jersey, and Connecticut area. Create designed to give families access to high-quality healthcare at immediate lower cost.
An innovative solution for self-funded group plan sponsors looking for affordable health insurance, Create immediately reduces healthcare costs while simultaneously increasing healthcare quality, through choice among integrated health systems.
Create health plans are built around leading, high-value, integrated health systems of hospitals and doctors that offer comprehensive care and expertise in a wide range of specialties.
When members enroll in a Create health plan, they are signing up to get all of their care from a single, high-quality health system during the plan year. This design motivates providers to improve the patient experience and total cost of care on an ongoing basis versus the one-time changes from other network models. The greater proportion of care the member receives in-system, the greater the cost improvements as well as quality improvements through enriched electronic medical records.
Misaligned incentives – across healthcare provider, plan sponsor, and patient – regarding economic and clinical value is the key barrier to improving healthcare cost and quality.
Today’s employer-sponsored health insurance plan is built on an “Open Access” provider network model. In Open Access, high-value providers are not rewarded for outperforming. What’s missing is a competitive marketplace like in most other industries in America. In a healthcare marketplace, providers would compete for consumer loyalty and be accountable for performance. The highest value providers would win, and competition would drive cost down and quality up.
“Positive enrollment” – allowing families to choose which healthcare system to align with – means providers will be fully accountable for the prices they charge and the quality of care that they deliver.
Create is driven by the belief that market-based competition between healthcare providers is the single approach that can quickly improve the cost and quality of healthcare.
Create introduces competition into the health system model that dominates NY/NJ/CT healthcare. Participating health systems bring down total of cost of care to win and keep families loyal to their system.
At Open Enrollment, employees shop and select among the competing health system-branded plans – or they can choose the higher-cost open access PPO plan if available – for the next plan year. Families actively compare plans based on cost per paycheck, available services and providers, geographies, and more.
Because members positively enroll with the health system plan of their choice, they then keep their family’s care within that system. Positive enrollment means families and healthcare providers are fully aligned, and providers can be held more accountable than in an attribution model.
Broad networks are costly and inefficient. One of the issues with broad networks is that it’s difficult to drive members to high-performing, high-value providers. Broad networks are also rife with waste: According to US government research findings, approximately 30-40% of healthcare expenses is spent on ‘overuse, underuse, misuse, duplication, system failures, unnecessary repetition, poor communication, and inefficiency.’* Lack of coordination between non-integrated providers results in fragmented care that leads to overutilization of healthcare services – such as redundant testing. And, broad networks struggle with effective medical management, often employing a constellation of third-party specialty vendors that lack coordination within the broader portfolio, adding cost and complexity, and with debatable impact on savings and quality.
Create is more cost-effective than open access plans while providing families access to top doctors and hospitals near where they live or work. Since Create keeps a family within a single integrated health system, they develop a closer relationship with their doctors, especially their primary care physician, who makes sure they get the right care, in the right setting, by the most appropriate provider, and in a manner consistent with their preferences and values. Actual integration between all providers – through shared electronic medical records, or EMR – improves the quality and delivery of care.
Create offers the first and only solution where all stakeholders win. Create generates supply-side competition while also fully aligning the interests of employers, consumers, providers, and health plans. It incentivizes providers through top-line growth and deeper patient loyalty and helps the best providers win.
*National Academy of Engineering and Institute of Medicine report: Building a Better Delivery System. Washington DC. National Academies Press.
The savings result from several sources:
- Competition between the Create® health systems for subscriber enrollment – not just in the first year but over multiple years
- Better unit costs from Create health systems because they earn increased "keepage" (more patients staying within their health system)
- Increased keepage results in reduced waste and fragmentation of care, which enable better clinical outcomes
- - Health systems achieved 87% to 93% “keepage,” which is not achieved in other models or narrow networks. By visiting providers in a single integrated health system, members develop long-term relationships with their doctors – which has been shown to lead to better outcomes. Care is better-coordinated among all providers through shared electronic medical records, reducing waste and contributing to better diagnoses and outcomes.
- - 98% of families stayed loyal to their doctors and hospitals by renewing with the same health system for subsequent years.
- - Members experienced 16% fewer hospital admissions, 11% fewer readmissions, 14% fewer ER visits.
- - Mount Sinai Health System
- - Hackensack Meridian Health
- - Long Island Health Network and Catholic Health Services of Long Island
- - Englewood Hospital and Medical Center
- - Saint Peter’s Healthcare System