Company type | Nonprofit |
---|---|
Industry | Health Insurance |
Key people |
|
Products | Healthcare services Health insurance |
Website | www |
EmblemHealth is one of the United States' largest nonprofit health plans. It is headquartered at 55 Water Street in Lower Manhattan, New York City. [1] It is a multi-billion-dollar organization with over 3 million members. [2]
EmblemHealth was created in 2006 through the merger of Group Health Incorporated (GHI) and the Health Insurance Plan of Greater New York (HIP). GHI and HIP had been operating as separate companies in the New York region since 1937 and 1947, respectively. [3]
GHI – originally named Group Health Association of New York – was established in 1937 to provide New York's working families access to medical services. [4] [5] This new health care model was built around a network of participating providers and was a precursor to today's preferred provider organization (PPO). [5] [6]
In order to expand its presence in the upstate New York market, GHI established GHI HMO as an incorporated entity in May 1999. [5] The following month, GHI HMO acquired certain assets of Well Care Management Group, Inc. [6]
In August 2005, GHI Select HMO acquired the assets, including the membership, of ABC Health Plans, which provides managed care services to Medicaid, Family Health Plus and Child Health Plus enrollees in Manhattan and The Bronx, New York. [7] [8]
Health Insurance Plan of Greater New York (HIP) was incorporated in 1944 as the first health insurance plan for public service workers. [9] The company was founded by David M. Heyman with the support of New York City mayor Fiorello LaGuardia, who wanted to offer medical services to New Yorkers of “moderate means.” [10] HIP got its first members in 1947. [11]
In 1997, HIP began offering its members medical services through a physician provider network, in addition to its medical centers. [6]
In 2001, HIP acquired Vytra Health Plans Long Island along with certain related entities. [12] Due to their steadily worsening financial condition, the decision was made to merge these entities into HIP, effective March 29, 2006. [6]
In March 2005, HIP acquired ConnectiCare Holding Company, Inc., a Connecticut corporation and its subsidiaries. [13] ConnectiCare was established in 1981. [14] ConnectiCare serves approximately 245,000 members in a service area that includes the entire State of Connecticut; Berkshire, Hampshire, Hampden, Franklin and parts of Worcester counties in Massachusetts; and Westchester, Rockland, Putnam and Orange Counties in New York. [6] [13] ConnectiCare's members had access to a provider network of approximately 19,900 health care providers prior to the merger. [6]
On September 29, 2005, the boards of directors of GHI and HIP announced an agreement to merge the two companies. [13] The resulting company, to be named EmblemHealth, would be governed by a Foundation made up of an equal number of directors from both companies. [3] [13]
Anthony Watson, then chairman and CEO of HIP, managed the 2006 merger, which created the largest health insurer based in New York State. [3] [13] Watson's compensation, $8.8 million in 2011, was often discussed. [15] In contrast, Mark Wagar, president and CEO of Empire Blue Cross and Blue Shield (part of Anthem), the largest New York insurer, was paid $2.2 million. [15]
In May 2013, Frank Branchini became chairman and chief executive officer, succeeding Watson, who retired. [15]
In November 2012, EmblemHealth began a program called Neighborhood Care to provide health services, including health screenings, exercise classes and referral assistance, to underserved communities. [16] [17] The first two Neighborhood Care facilities were located in Harlem and Cambria Heights, Queens. [18] [19] Two additional Neighborhood Care sites were established in Chinatown in December 2013 [20] and in Crown Heights in April 2016. [19] [21]
In January 2013, EmblemHealth announced a partnership with AdvantageCare Physicians (ACPNY).[ citation needed ]
On May 21, 2015, it was announced that Karen Ignagni, CEO of America's Health Insurance Plans (AHIP), would leave the industry's lobbying group to become president and CEO of EmblemHealth, effective September 1, 2015. [22] Ignagni, who spent more than 20 years with AHIP, replaced Frank Branchini. [23]
In February 2016, EmblemHealth announced a new partnership with the City of New York and the Municipal Labor Committee to provide expanded access to health care. [24] The partnership was also developed to support the city's goal of health care cost savings for NYC taxpayers. [25]
On March 25, 2016, EmblemHealth announced a two-year partnership agreement with Northwell Health. [26] [27]
In March 2020, EmblemHealth was named the winner of two Stevie Awards at the 14th annual Stevie Awards for Sales & Customer Service. [28]
HIP owned LaGuardia Hospital from 1964 thru 1996. [29] [30] GHI owned Hillcrest General Hospital during a similar period. [31] [32]
In the United States, a health maintenance organization (HMO) is a medical insurance group that provides health services for a fixed annual fee. It is an organization that provides or arranges managed care for health insurance, self-funded health care benefit plans, individuals, and other entities, acting as a liaison with health care providers on a prepaid basis. The US Health Maintenance Organization Act of 1973 required employers with 25 or more employees to offer federally certified HMO options if the employer offers traditional healthcare options. Unlike traditional indemnity insurance, an HMO covers care rendered by those doctors and other professionals who have agreed by contract to treat patients in accordance with the HMO's guidelines and restrictions in exchange for a steady stream of customers. HMOs cover emergency care regardless of the health care provider's contracted status.
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...intended to reduce unnecessary health care costs through a variety of mechanisms, including: economic incentives for physicians and patients to select less costly forms of care; programs for reviewing the medical necessity of specific services; increased beneficiary cost sharing; controls on inpatient admissions and lengths of stay; the establishment of cost-sharing incentives for outpatient surgery; selective contracting with health care providers; and the intensive management of high-cost health care cases. The programs may be provided in a variety of settings, such as Health Maintenance Organizations and Preferred Provider Organizations.
In U.S. health insurance, a preferred provider organization (PPO), sometimes referred to as a participating provider organization or preferred provider option, is a managed care organization of medical doctors, hospitals, and other health care providers who have agreed with an insurer or a third-party administrator to provide health care at reduced rates to the insurer's or administrator's clients.
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Michael J. Dowling is president and chief executive officer of Northwell Health.
Health Insurance Plan of New Jersey or HIP of New Jersey was a Health Maintenance Organization in New Jersey that was declared insolvent in 1998 and filed for bankruptcy in 1999. The bankruptcy left some people with no insurance coverage. Jaynee LaVecchia, the State Commissioner of Banking and Insurance, proposed legislation to create a fund to pay the costs of future HMO failures in New Jersey. The company offered a range of health insurance plans for individuals, families, and small businesses, including HMO, PPO, and EPO plans. HIPNJ also offers a range of additional services, such as wellness programs and resources for managing chronic conditions.
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The history of health care reform in the United States has spanned many decades with health care reform having been the subject of political debate since the early part of the 20th century. Recent reforms remain an active political issue. Alternative reform proposals were offered by both of the major candidates in the 2008, 2016, and 2020 presidential elections.
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Hillcrest General Hospital was opened around 1962 by a physician who "was chief of medicine there for 25 years." Hillcrest, a private hospital, was then sold to an investor, who leased it to Osteopathic Hospital and Clinic. Osteopathic previously had acquired another hospital to which they subsequently relocated, and the 5-story building became St. Joseph's Hospital in 1985.
at Forest Hills Hospital dates back to 1976, when it was known as LaGuardia Hospital.
In 1974, GHI purchased Hillcrest General Hospital
Hillcrest General Hospital-G.H.I. Group Health Incorporated